CO 109 Denial Code: Avoiding Denials
Basics of Denial Code CO 109
Denial Code CO 109 – Claim or Service not covered by this payer or contractor. You must send the claim/service to the correct payer/contractor. Denial Code CO 109 tells you that you might have a coordination of benefits (COB) issues to resolve. If you are getting a lot of these you know you need work at the front desk. Submit the claims to the Primary carrier. If the patient said there is no primary insurance then ask the patient to call Medicare and update as Medicare is primary. After this process resubmit the claims and it will be processed.
Common Remark Codes for CO 109
Remark Code N418: Misrouted claim
What to do next? : See the payer’s claim submission instructions.
Remark code MA101: If patient enrolled in SNF at the time of DME service billed
What to do next?: Write off. If the beneficiary not enrolled at the time DME service provided, then reopen the claim and send re-determination along with supporting documents.
Remark code N104: When claim submitted to a different region (Other than the beneficiary lives in)
What to do next?: Update the correct address and submit the claim to the corresponding region in order to process the claim correctly.
Medicare HMO & CO 109
If Medicare HMO record has been updated for date of service submitted, a telephone reopening can be conducted. A Redetermination request may be submitted with all relevant supporting documentation if HMO record has been updated for date of service submitted. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and documentation checklists prior to submitting request.
SNF & CO 109
If the patient is in a SNF for those dates of service, if the patient was discharged within two days of the delivery date, the provider can rebill the claim based on the date of discharge. However, it is advisable to have a copy of the discharge summary on hand to prove the actual discharge date in case of a post-pay audit.
Researching and resubmitting claims with common denial codes like CO 109 denial code can lead to long, frustrating hours trying to figure out why the claim was denied in the first place. The good news is that on average, 63% of denied claims are recoverable and nearly 90% are preventable. E2E Medical Billing Services can assist you in addressing these denials and recover the insurance reimbursement. For more information, feel free to call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com