22Denial Code (CARC)Active
CARC 22 Denial Code - Coordination of Benefits Fix
CARC 22 indicates that the claim may be covered by another insurance payer due to coordination of benefits. This means the current payer believes another insurance is primary or involved in covering the claim.
Who Pays: Group Code Liability
When CARC 22 appears with group code CO, the provider typically cannot bill the patient, and must pursue payment from the primary payer. If group code PR appears, the patient may be responsible, but this is less common for this code.
Why Claims Get Code 22
- The patient has dual insurance coverage and the primary payer is not billed first.
- Incorrect insurance information is on file, leading to misdirected claims.
- The claim was submitted to the secondary payer without an EOB from the primary payer.
- Coordination of benefits information was not updated in the payer's system.
- A lapse in communication between payers regarding the coordination of benefits.
How to Fix & Resubmit
- Verify the patient's insurance information for any dual coverage.
- Check if the claim was sent to the correct primary payer initially.
- Obtain the explanation of benefits (EOB) from the primary payer if applicable.
- Update the payer with correct coordination of benefits details if needed.
- Resubmit the claim to the correct primary payer or secondary payer with appropriate documentation.
Corrected Claim or Appeal?
A corrected claim is appropriate when initial submission errors are found, such as incorrect primary payer billing. An appeal may be needed if the payer's coordination of benefits decision is disputed.
Preventing Future 22 Denials
- Verify and update patient insurance details at every visit to ensure correct payer order.
- Train staff on identifying and inputting coordination of benefits information accurately.
- Implement a system to track and verify primary payer EOBs before secondary submissions.
- Regularly audit claims for coordination of benefits errors to catch issues early.