CO-19: Claim Lacks Information for Adjudication
CO (Contractual Obligation)What is CO-19?
CO-19 is a Contractual Obligation code indicating the claim does not have enough information for the payer to determine benefits. Additional documentation or data fields are needed before the payer can process the claim.
Why Does CO-19 Occur?
- Missing required fields on the claim form (e.g., referring provider NPI, onset date, prior auth number).
- Accident or injury information not provided when required by the payer.
- Additional clinical documentation requested but not received.
- Incomplete or invalid subscriber information.
How to Fix CO-19 Denials
- Check the RARC code on the EOB to identify exactly what information is missing.
- Gather the missing data from your PM system, clinical records, or the patient.
- Resubmit the claim with all required fields populated.
- If the payer's request is unclear, call the provider services number for clarification before resubmitting.
CO-19 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | Varies | 60 days from remittance | Reconsideration required before formal appeal. |
| Anthem | Varies | 365 days from denial notice | Check state-specific provider manual for variations. |
| Aetna | Varies | 180 days from denial | Strict in-network filing enforcement. |
| Cigna | Varies | 180 days from denial | Cigna COB team: 1-800-244-6224. |
| Medicare | Varies | 120 days (redetermination at MAC) | Five levels of appeal starting with MAC redetermination. |
Related CARC Codes
If you are seeing CO-19, check these related codes: CO-16 (claim differs), CO-45 (fee schedule), CO-29 (timely filing).
Common Questions About CO-19
What does CO-19 mean?
CO-19 indicates claim lacks information for adjudication. Check the RARC code on the EOB for the specific reason and follow the resolution steps above.
Can I appeal a CO-19 denial?
Yes. Commercial payers allow 60-365 days to appeal depending on the payer. Gather supporting documentation before filing. Medicare allows 120 days for a redetermination request.
Altair catches CO-19 denials before submission with claim completeness checking. See how pre-submit claim scoring works.