Denial Code CO 111 - Resolve & Prevent Assignment Issues
Code 111 means the service in question is not covered under the patient's plan unless the provider has accepted assignment of benefits. This often relates to services where the payer requires the provider to agree to certain payment terms before they will cover the service.
Who Pays: Group Code Liability
When code 111 applies, liability depends on whether the provider has accepted assignment. If the provider has accepted assignment, the group code is typically CO, meaning the provider must write off the amount. If not accepted, PR applies, making it billable to the patient.
Why Claims Get Code 111
- Provider did not accept assignment for the service.
- Patient's plan requires assignment acceptance for coverage.
- Service performed by an out-of-network provider.
- Incorrect claim form submission indicating no assignment.
- Patient's plan explicitly excludes non-assigned services.
How to Fix & Resubmit
- Verify if the provider has accepted assignment for the service.
- Check the patient's insurance plan details for assignment requirements.
- If the provider accepts assignment, submit a corrected claim indicating acceptance.
- If assignment is not accepted, determine if the patient should be billed.
- Contact the payer for clarification if the assignment status is unclear.
Corrected Claim or Appeal?
Submit a corrected claim if the provider has accepted assignment but it was not indicated properly. If the service is legitimately non-covered due to no assignment, billing the patient may be appropriate.
Preventing Future 111 Denials
- Ensure assignment acceptance is documented for applicable services.
- Train staff to verify assignment requirements during registration.
- Review payer contracts to understand assignment clauses.
- Implement a checklist for claim submission to confirm assignment indication.