24Denial Code (CARC)Active
CO 24 Denial Code: Capitation Agreement Info & Fixes
Code 24 indicates that the charges for the service are covered under a capitation agreement or managed care plan. This means the provider has already received payment through a fixed amount per patient, so no additional reimbursement is due for this service.
Who Pays: Group Code Liability
Under group code CO, the provider must write off the charge as a contractual obligation, and the patient cannot be billed for this amount.
Why Claims Get Code 24
- The patient is enrolled in a managed care plan where services are prepaid.
- The service was billed separately despite being covered under an existing capitation agreement.
- The billing staff was unaware of the patient's capitation plan coverage.
- The provider is part of a network with a capitation agreement for the patient.
- The service was not verified against the capitation agreement before billing.
How to Fix & Resubmit
- Verify the patient's insurance details to confirm capitation plan enrollment.
- Check the capitation agreement terms to ensure the service is covered under the plan.
- Contact the payer if there is a discrepancy in capitation coverage understanding.
- Adjust the billing records to reflect the capitated payment status.
- Write off the charge as a contractual obligation under group code CO.
Corrected Claim or Appeal?
For code 24, a formal appeal is not applicable as the adjustment is legitimate under the capitation agreement. No corrected claim is needed; instead, adjust records to reflect the capitation coverage.
Preventing Future 24 Denials
- Verify patient insurance coverage details during registration to identify capitation plans.
- Ensure billing staff are familiar with capitation agreements and managed care plans.
- Regularly update the provider's system with current capitation agreements.
- Train staff to cross-reference services with capitation agreements before billing.