RemitBench/Denial codes/CO-B9

CO-B9 denial code

Code B9 is not about your service. It is about the patient's enrolment. Once someone elects hospice, a large part of their care is paid through the hospice rather than through normal claims, and this code says your claim landed on the wrong side of that line.

The code list's own wording: Patient is enrolled in a Hospice.

What it means: The patient elected the hospice benefit. Care connected to the terminal condition is the hospice's financial responsibility, so a claim sent the usual way is denied even though the care happened and was needed.
Who owes the money: Not the patient Do not bill the patient. This is an arrangement between payers and providers, and the patient elected a benefit they were entitled to. The money is somewhere, and that somewhere is usually the hospice.
Is appealing worth it: Rarely the right move. Two better routes exist: bill the hospice under your arrangement with them, or show that the service was unrelated to the terminal condition, which is a claim resubmission rather than an appeal.

There is a payer here, it is just not the one you billed. A hospice denial is not a coverage denial. Somebody is responsible for the cost of that care. Treating a B9 as a write-off without contacting the hospice gives away money for care you actually provided.

Why the payer sent it

The service was related to the terminal condition, so it belongs to the hospice benefit.
The patient elected hospice and the election had not reached your systems yet.
The service was genuinely unrelated to the terminal condition and was not flagged as such.
The provider is not the patient's attending physician of record with the hospice.
The dates overlap the election, so part of a course of care falls each side of it.

Remark codes you will see with it

Remark code	What it adds
N130	Read the plan document. Its own page.
MA130	The claim is unprocessable as sent and no appeal rights attach. Points at a resubmission rather than an appeal.

Remark code

What it adds

N130

Read the plan document. Its own page.

MA130

The claim is unprocessable as sent and no appeal rights attach. Points at a resubmission rather than an appeal.

Read the letters in front of the B9

CO-B9: Contractual obligation. Your write-off unless you find the right payer, and there usually is one.
PI-B9: Payer initiated. Also not the patient's money.
OA-B9: Other adjustment. Often signals the claim is being pointed at another payer.

What to do next

Confirm the hospice election dates

Election and revocation dates decide everything here. A service the day before an election is a normal claim, and a service the day after is not.
If your date is outside the election: resubmit. The denial was applied to the wrong period.
Decide whether the care was related to the terminal condition

This is the whole test. Unrelated care can still be billed normally, but it has to be identified as unrelated, and the documentation has to support it.
If it was unrelated: resubmit with the documentation and the appropriate indicators for that payer.
Contact the hospice

If the care was related, the hospice is responsible. Most hospices have arrangements for paying outside providers, and a phone call is much shorter than an appeal.

Codes that get mixed up with B9

Code	How it differs from B9
109	Not covered by this payer, send it elsewhere. The general version of what B9 is doing. See CO-109.
24	Covered under a capitation agreement. Another case of the money living somewhere other than a fee for service claim. See CO-24.
22	Another payer may be primary. See CO-22.

Code B9 in dental

Uncommon on dental claims and worth recognising when it appears. Dental care for a hospice patient is usually unrelated to the terminal condition, which means it can often be billed normally once that is established.

Unrelated is the normal answer in dentistry

A broken tooth or an infection is not usually part of the terminal condition. That is the argument, and it is a strong one, but it has to be made rather than assumed. Contact the hospice first, because they will tell you which route they expect.

Questions people ask about CO-B9

Can I bill the patient for a CO-B9?

No. The patient elected a benefit they were entitled to, and the responsibility sits between you, the payer and the hospice. Contact the hospice instead, because for care related to the terminal condition they are usually the ones who pay outside providers.

What if the service had nothing to do with the terminal illness?

Then it can normally be billed as usual, but it has to be identified as unrelated on the claim and the documentation has to support that. This is a resubmission with the right indicators rather than an appeal.

Related codes

Back to all denial codes

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