When insurance claims are denied due to coordination of benefits (COB) issues, the financial impact can be significant. Billing teams face delays, rework, and uncertainty — all of which put practice revenue at risk.
COB is one of the abbreviations in medical billing that you need to know, and coordination of benefits denial code 22 is one of the most common you’ll encounter. You need to know what denial code 22 means, why it happens, and how to prevent it. This will help you reduce write-offs and improve cash flow.
With Rivet Health’s payer performance tools, you can quickly identify and resolve these denials before they damage your revenue cycle. Here is an explanation of the coordination of benefits denial code 22.
Coordination of benefits denial code 22 is the process insurers use to determine which plan pays first when a patient has more than one health insurance policy. When COB isn’t correctly verified, claims can be denied.
Denial code 22 is issued when the claim was sent to the wrong payer as the primary. This commonly happens when:
Suppose that a payer has Medicare and a separate policy. In this case, Medicare may deny the claim because it should have been billed as secondary, not primary. In these instances, your billing staff must correct and resubmit the claim.
The good news is that a CO 22 denial code does not mean that the claim is invalid. It means it went to the wrong payer first. However, if you don’t fix the problem, the provider won’t get paid. If you wait too long, you may be unable to recover money for the services you provided.
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Coordination of benefits denials typically occur when there is confusion or missing information about which payer is responsible for covering a patient’s claim. While denial code responses can stem from a variety of circumstances, three causes are especially common in day-to-day billing operations:
One of the biggest drivers of COB denials is outdated coverage. Patients may switch jobs or add dependents. They may enroll in Medicare without informing the practice. If the billing system isn’t updated, claims are sent to the wrong payer. Since payers process claims strictly based on what they have on record, even small delays in collecting new insurance details can trigger a denial.
Determining which insurer is “first in line” is not always easy. For example, Medicare is typically only secondary when a patient still has active employer group coverage. In family scenarios, the “birthday rule” often decides which parent’s plan is primary for dependents. If these rules are overlooked or misunderstood, the wrong payer gets billed, resulting in a COB denial code such as CO 22.
Even when coverage details are correct, manual errors can cause denials. A mistyped policy number, a missing subscriber ID, or a skipped eligibility check can invalidate the claim. You need to implement automated eligibility verification processes and consistently review patient data to catch these issues before you submit a claim.
The most effective way to handle coordination of benefits denial codes is to stop them before they occur. Prevention begins at patient check-in. Your team should verify insurance at every visit, even for long-time patients. Failing to confirm that a patient’s insurance coverage is the same opens the door for COB 22 denials.
Your staff should also ask detailed coordination questions during intake. Instead of only recording the primary policy, intake teams need to clarify whether the patient has additional coverage, such as a spouse’s employee plan or Medicare. If a patient has more than one policy, your team should document which is primary versus secondary to reduce confusion later.
Improving medical coding accuracy is another step toward preventing COB denials. If your billing team is consistently inputting billing data with near-perfect accuracy, there is a much lower chance of having claims kicked back.
Finally, your practice can lean on technology by using EHR/EMR rules to flag payer hierarchy. Many systems allow you to assign primary and secondary payers in the patient record. When claims are submitted, these designations ensure the right payer receives the claim first.
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Here are some medical coding strategies to address CO 22 denial code issues:
These simple tips can have a huge impact on your bottom line and reduce bleeding associated with code 22 denials.
COB denials slow payments and disrupt workflows, but they are highly preventable. By validating coverage, training staff, and adopting supportive technologies, you can minimize denial volume and boost cash flow. Rivet Health’s platform takes this further by:
Rivet Health’s denial prevention solution can level the playing field and give you the insights necessary to overcome coordination of benefits denial code 22, as well as other common COB denial reasons.
Schedule a demo with Rivet Health.