RemitBench/Denial codes/CO-22

CO-22 denial code

Code 22 says you sent the claim to the wrong plan first. The patient has more than one, and the order they are billed in is decided by rules rather than by preference.

The code list's own wording: This care may be covered by another payer per coordination of benefits.

Why the payer sent it

• The patient genuinely has two plans and this one is secondary.
• The payer's records show other coverage that has ended and was never updated.
• A child is covered by both parents and the claim went to the wrong one first.
• The patient has Medicare plus another plan, where the order depends on the circumstances.
• A work injury or an accident makes a different carrier primary, which is closer to CO-19.

Remark codes you will see with it

The remark usually tells you the payer is willing to process this, and is missing the primary's answer.

Read the letters in front of the 22

What to do next

1. Ask the payer which plan it shows as primary

   The fastest possible answer. They denied on the basis of a record, and that record names the other plan.

   If the other coverage has ended: the patient has to update it with the plan. Practices cannot usually correct another plan's coordination record.

2. Bill the primary and wait for its remittance

   You need the actual remittance, not a phone confirmation. The secondary will ask for it.

3. Resubmit here with the primary remittance attached

   Attached properly and linked to the claim. A secondary claim without the primary's adjudication is what produces MA04 and starts the cycle again.

4. Fix the coverage record in your own system

   Record which plan is primary once you know. Otherwise the next claim goes out in the same wrong order.

Codes that get mixed up with 22

The distinction that matters most: a 22 means right payer, wrong order. A 109 means wrong payer entirely. One is resubmitted after the primary answers, the other is sent somewhere else.

Code 22 in dental

Dual dental coverage is common in families, and dental coordination is stricter about sequence than most patients expect. This is one of the highest volume dental denials that has nothing wrong with the claim itself.

Children on two parents' plans

The usual rule looks at the parents' birthdays rather than their ages, and it is not intuitive. Families frequently assume the plan of whichever parent brought the child is primary. Ask the carrier rather than assuming, and record the answer in the patient file so the next visit is routed correctly.

Coordination does not always mean the second plan pays the rest

Dental plans coordinate in more than one way. Some pay up to what they would have paid alone, which can be nothing once the primary has paid. Telling a patient that their second plan will cover the balance is a promise you cannot keep until you have seen how that plan coordinates.

Questions people ask about CO-22

Which plan is primary?

It depends on how each plan covers the patient, and it is set by rules rather than preference. For a child covered by two parents, most plans follow a birthday rule based on which parent's birthday falls earlier in the year. The reliable answer is to ask the payer which plan it shows as primary.

Can I bill the patient for a CO-22?

No. The patient has coverage. The claim went to their plans in the wrong order, which is a billing office problem. Bill the primary, then resubmit here with the primary's remittance attached.

Why did I get a CO-22 when the patient only has one plan?

Because the payer's records say otherwise, usually because old coverage was never removed. The patient generally has to update that with the plan directly, since a practice cannot correct another payer's coordination record.

Related codes

• CO-23 The prior payer's adjudication. What a correctly ordered secondary claim looks like.
• CO-109 Wrong payer entirely rather than wrong order.
• MA04 The primary payer's information is missing.
• CO-19 A work injury, where a compensation carrier is liable.

Back to all denial codes