239Denial Code (CARC)Active
CO 239 Denial Code - Split Claims for Coverage Issues
CARC 239 indicates that the claim includes services provided during both eligible and ineligible periods of the patient's coverage. This means the claim needs to be split and rebilled to separate the covered and non-covered dates of service.
Who Pays: Group Code Liability
CO applies to the ineligible portion, meaning the provider writes off these charges and cannot bill the patient. PR applies to the eligible portion, allowing the patient to be billed for any applicable cost-sharing.
Why Claims Get Code 239
- The patient's insurance coverage ended partway through the treatment period.
- The claim was submitted with a date range that includes a lapse in coverage.
- A temporary change in the patient's insurance status was not accounted for.
- The patient's policy had a waiting period that overlapped with the claim dates.
How to Fix & Resubmit
- Verify the patient's coverage dates to determine which services were during eligible and ineligible periods.
- Split the original claim into two separate claims: one for the eligible period and another for the ineligible period.
- Submit the corrected claim for the eligible portion to the payer for processing.
- Adjust your records to reflect the write-off for the ineligible portion under the CO group code.
- Bill the patient for any applicable cost-sharing on the eligible portion, if allowed.
Corrected Claim or Appeal?
Submit a corrected claim after splitting the original claim into eligible and ineligible portions. An appeal is not typically necessary unless there is a mistake in the coverage dates.
Preventing Future 239 Denials
- Verify patient coverage dates before claim submission to ensure accuracy.
- Use eligibility verification tools to check for any lapses in coverage during the treatment period.
- Educate registration staff to gather accurate insurance information at each visit.
- Implement a billing review process to catch claims spanning coverage changes before submission.