Understanding denial codes in medical billing can impact your ability to recover the revenue you are owed, so it's important to have a deep understanding of when and why denials may occur. In this blog, we'll dive into denial code CO-109, why it happens, and what you can do to resolve it.
CO-109 Denial Code: Meaning
The CO-109 denial code indicates a claim was rejected due to the coordination of benefits. Specifically, this code is “Claim/service denied because this procedure code was incorrect.” You may see this code referred to as “denial code 109” or “code 109.”
Coordination of benefits occurs when an insured person has more than one insurance policy. This typically indicates the person has at least a primary and a secondary insurer, and those two parties have not coordinated their responsibility. This can lead to confusion, disputes, and denials of claims, including a denial code like this.
Receiving a CO-109 denial code typically means that coordination of benefits between two or more insurance companies must take place. Once that is done, the payment responsibilities of each party will be understood, and your claim can begin processing.
A Real-Life Example of Co-109 Denial Code
If, for example, Mrs. Smith has primary insurance coverage from her employer and a secondary level of coverage from her spouse’s policy, she effectively has two parties that could cover some or all of her health insurance costs.
If Mrs. Smith has a surgical procedure and no coordination of benefits takes place, the incorrect insurance company could be billed for the service. This would result in denial code CO-109.
Why Does Denial Code CO-109 Happen?
Several factors can cause a CO-109 denial code to occur. The CO 109 denial code reason could include:
- Out-of-network services: This code may occur if a service is not covered under the plan because the provider is out-of-network. Often, this occurs when necessary pre-authorization does not happen.
- Incorporate payer information: The provider submitted the claim to the wrong payer or contractor. This may be due to inaccurate patient insurance information or confusion over which policy should provide coverage.
- No pre-authorization obtained: In some cases, pre-authorization was not obtained prior to the service being applied, especially if there is a lack of coordination of benefits. This may also occur with CO-197.
- Incorrect coding: In some cases, the wrong procedure code or diagnosis code leads to the overall denial.
- Coordination of benefits issues: If multiple insurance plans have not applied coordination of services, the wrong provider may receive a bill first.
Other concerns include issues with coding policies and a lack of supporting documentation. A variety of factors could contribute to this, including updates to payer policy updates or coverage maintained by the patient. It is not uncommon for this code denial to occur due to non-practice mistakes.
How to Resolve Denial Code CO-109
Take a closer look at the CO 109 denial code and the action you can take to eliminate this problem. Follow these steps for a CO 109 denial code solution:
1. Verify payer information is accurate
Prior to submitting a claim, ensure the information about the payer responsible for the claim is up to date. This may include double-checking:
- Policies
- Requirements for submission
- Guidelines to ensure eligibility
2. Determine eligibility mistakes.
When possible, verify all qualifications for patient insurance coverage eligibility prior to providing a service. If pre-authorization is necessary, that must come first. Ensure, too, that all information from the patient is up-to-date with current insurance coverage. Receiving denial code CO-177 may also indicate eligibility errors.
3. Review contract agreements
Read the contractor agreements that are in place between the payer and the practice. Ensure you know what is and is not covered. If you believe the coverage was justified, resubmit claims with accurate information that clearly outlines the missing information (if applicable) or updated coordination of benefits. Make sure the claim is submitted on time. Denial code CO-29 may also apply here.
How Adonis Helps with Denial Codes
Submit claims faster and more accurately with Adonis Billing. Adonis Billing delivers automated pre-certification checks, touch-free claim submissions, and real-time denial mitigation strategies to streamline your billing operations and improve recovery.
Learn how we can help you manage any denial codes holding your practice back.
