CO-22 Denial Code For Coordination of Benefits Required

A CO-22 denial occurs when a claim cannot be processed because the payer requires updated Coordination of Benefits (COB) information. This typically happens when a patient has more than one active insurance policy, but the order of coverage has not been confirmed or properly communicated. Since payers must determine which insurer is responsible for processing the claim first, incomplete or outdated COB details can delay adjudication. Understanding why CO-22 denials occur is essential for ensuring accurate benefit coordination, preventing processing delays, and maintaining clean claim submission.

What CO-22 Means

A CO-22 denial indicates that the payer needs updated Coordination of Benefits (COB) information before the claim can be processed. When a patient has multiple active insurance plans, payers require confirmation of which insurance is primary, secondary, or tertiary to ensure claims are billed in the correct order. If this information is missing, outdated, or unclear, the payer cannot determine liability and therefore denies or pauses the claim. COB safeguards against duplicate payments and ensures that benefits are applied according to payer rules.

Common Reasons for CO-22

Incorrect primary/secondary insurance listed:

Claims are denied when the insurance listed as primary is actually secondary, or vice versa. This typically happens when coverage changes and records are not updated promptly.

COB information not updated with the payer:

Payers periodically require updated coordination details. If they lack current information, they suspend or deny the claim until confirmation is received.

Patient failed to confirm or update coverage details:

Many plans require the member to complete COB questionnaires. If a patient does not respond, the payer halts all claims until updates are provided.

Claim sent to the wrong payer first:

If the claim is sent to the secondary payer before the primary, it will be denied automatically because the primary payer must process the claim first.

Payer requires updated coordination questionnaire:

Some insurers mandate a yearly or periodic COB form. If this form is not completed, the payer considers the COB incomplete.

Overlapping or duplicate coverage detected:

When payer systems detect another active insurance policy, such as employer coverage plus Medicaid, they flag claims until the coordination hierarchy is verified.

Why CO-22 Denials Occur

CO-22 denials happen when payers cannot determine which insurance plan is responsible for processing the claim first. When multiple policies exist, even small discrepancies in coverage details can pause or stop adjudication. The reasons below explain why payers frequently issue CO-22 denials and how coverage coordination issues disrupt claim processing.

Incorrect insurance order submitted

The most common cause is listing the secondary insurance as primary, or vice versa. If the payer’s system shows a different order than the claim, it cannot process payment until the correct hierarchy is confirmed.

Outdated COB information on file

Payers periodically request updated coverage details. If the patient or provider fails to supply this information, claims cannot move forward. Insurers flag outdated COB as a compliance risk and deny until updates are received.

Claim submitted to the wrong payer first

When a claim is billed to the secondary payer before the primary payer, the system rejects it automatically. Secondary payers require the primary insurer’s EOB/ERA before they can consider payment.

Conflicting or overlapping coverage

If a patient has two active plans, such as employer coverage plus a spouse’s insurance, payers must determine which plan holds responsibility. Any conflict, such as unclear enrollment dates or overlapping coverage, results in a CO-22 denial.

The patient did not complete the required COB questionnaire

Some insurers require yearly or event-based COB forms. If the patient does not respond or update their information, the payer may suspend all claims until verification is completed.

Payer identifies another active policy through internal matching

Payers use data-matching systems to detect other coverage, such as Medicare, Medicaid, or employer insurance. When another plan is identified, claims are paused until coordination is verified and documented.

CMS & AAPC-Aligned Best Practices For CO-22

Preventing CO-22 denials requires accurate verification of insurance coverage, proactive communication, and strong administrative workflows. The following best practices ensure proper benefit coordination and cleaner claim submission.

Verify active insurance coverage at every visit

Insurance status can change frequently due to employment updates, new enrollments, or policy terminations. Verifying coverage at each encounter ensures payer records match the patient’s current insurance arrangement and prevents incorrect payer order submissions.

Confirm primary and secondary insurance based on COB rules

COB guidelines determine which plan pays first, for example, employer-sponsored plans before other coverage, or the birthday rule for dependents. Confirming these rules helps eliminate claim denials caused by incorrect payer sequencing.

Update payer records with the most recent coverage details

If a patient switches plans or adds new coverage, promptly updating the payer ensures their COB file remains accurate and up-to-date. Payers rely on this information to determine liability, making timely updates essential.

Use eligibility tools to detect multiple active policies

Eligibility and verification tools quickly identify when more than one insurance plan is active. These tools help staff determine coverage order before claims are submitted, preventing CO-22 delays.

Educate front-desk and registration teams on accurate insurance collection

Most COB issues begin at registration. Training staff to collect complete insurance details, including policy numbers, effective dates, and secondary coverage, helps prevent COB-related denials downstream.

Conduct internal audits to identify recurring COB errors

Regular reviews of denied claims reveal patterns, such as incorrect payer orders, outdated patient records, or inconsistent registration data. Addressing these trends strengthens workflows and reduces future CO-22 denials.

Corrective Action Steps For CO-22 Denial Code

Resolving a CO-22 denial requires verifying and updating the patient’s coverage details to ensure the claim is processed by the correct payer. The following steps outline how to correct coordination issues and prevent repeat denials.

Contact the patient or payer to confirm updated COB information

Begin by reaching out to the patient or payer to determine which plan is primary and whether the payer’s records reflect the same information. Obtain the most recent policy details, effective dates, and coordination hierarchy.

Update the patient’s insurance information in the billing system

Once verified, correct any outdated or incorrect insurance details in the EHR or billing software. This ensures future claims are sent to the right payer in the proper order.

Submit the claim to the correct primary payer first

If the claim was sent to the wrong payer, redirect it to the primary insurer. Wait for the primary payer’s remittance advice (EOB/ERA) before submitting the secondary claim.

Attach the EOB or ERA when billing the secondary payer

Secondary payers require proof of processing from the primary insurer. Include the EOB or ERA showing the primary payer’s adjudication to support payment by the secondary plan.

Resubmit the corrected claim with updated COB details

Once all information is verified and documentation is complete, resubmit the claim to the appropriate payer. Ensure the COB information is clearly reflected on the claim form.

Document all updates to prevent future COB issues

Maintain records of the patient’s updated insurance details, communication logs, and claim corrections. This documentation supports compliance and prevents recurring CO-22 denials.

BillingFreedom Your Medical Billing Partner For Accurate Coordination of Benefits & Clean Claims

BillingFreedom helps healthcare organizations eliminate CO-22 denials by ensuring patient insurance details are verified, updated, and accurately coordinated before claims are submitted. 

Our team confirms primary and secondary coverage, reviews payer rules, and ensures that COB information is always up to date. With real-time eligibility tools, proactive verification, and detailed claim audits, BillingFreedom prevents delays caused by incorrect payer sequencing. We streamline the entire COB process, ensuring that every claim reaches the correct payer the first time and proceeds through adjudication without unnecessary interruptions.

Our full-service RCM support also includes claim correction, EOB/ERA management, and expert follow-up to resolve denied or suspended claims quickly. BillingFreedom works closely with front-desk, billing, and administrative teams to strengthen registration workflows and eliminate recurring COB errors at the source. By partnering with BillingFreedom, practices reduce administrative burdens, improve clean-claim rates, and maintain a stable and efficient revenue cycle.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472.

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