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Last Modified: 8/26/2018 Location: FL, PR, USVI Business: Part B

Avoiding denial reason code CO 22 FAQ

Q: We received a denial with claim adjustment reason code (CARC) CO 22. What steps can we take to avoid this denial?
This care may be covered by another payer per coordination of benefits.
A: This denial is received when Medicare records indicate that Medicare is the beneficiary’s secondary payer.
To prevent this denial in the future, follow these steps before submitting claim to Medicare. If Medicare is the secondary payer, send claim to primary insurer for a determination before submitting to Medicare for a possible secondary payment.
Ask patient/representative to complete the Medicare Secondary Payer (MSP) Questionnaire external pdf file to help determine if Medicare is the primary or secondary payer.
Check patient eligibility and verify if Medicare is the secondary payer via the Secure Provider Online Tool (SPOT) or the interactive voice response (IVR) system. If Medicare is secondary, the following MSP details will be provided:
Via SPOT:
Effective date
Termination date
Insurer name
Policy number
Type of primary insurance
Address
Via IVR:
Type of primary insurance
Effective and termination date for all valid insurers for a current or previous date of service.
To resolve the denial:
Contact patient/representative and ask if patient insurance has changed. The Medicare Secondary Payer (MSP) Questionnaire external pdf file may also be completed at this time to help determine if Medicare is primary or secondary.
If patient insurance has changed, update your files for future reference.
To update patient Medicare records, you may place a conference call with the patient/representative and the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627.
If patient file is updated to indicate that Medicare is the primary payer on the date(s) of service, resubmit the claim to Medicare.
If Medicare is secondary, submit the claim to the primary payer for processing. After determination is made by the primary insurer, submit claim to Medicare for possible secondary payment.
Additional resource for information and to prevent this denial:
Medicare Secondary Payer (MSP) Part A/B web based training (WBT) via First Coast University external link
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