CO-22: Coordination of Benefits Required
CO (Contractual Obligation)What is CO-22?
CO-22 is a Contractual Obligation code indicating the claim requires coordination of benefits (COB) information. The payer believes another insurance is primary and needs that payer's EOB or adjudication before processing this claim.
Why Does CO-22 Occur?
- Patient has dual coverage and the secondary payer received the claim first. The secondary cannot process until the primary adjudicates.
- COB information is missing or outdated in the payer's system. The patient's other insurance was not reported during enrollment or verification.
- Incorrect payer order. The claim was submitted to the payer that should be secondary based on COB rules (birthday rule, employment status, etc.).
How to Fix CO-22 Denials
- Verify which payer is primary using COB rules: birthday rule for dependent children, employment status for Medicare Secondary Payer situations, and auto/workers comp priority for injury claims.
- Submit the claim to the primary payer first. Wait for the primary EOB.
- Once the primary EOB is received, submit the claim to the secondary with the primary's EOB attached showing the allowed amount, payment, and patient responsibility.
- If COB information in the payer's system is wrong, contact the payer to update the patient's coverage order before resubmitting.
CO-22 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | N/A | 60 days from remittance | UHC requires primary EOB attached to secondary claims. |
| Anthem | N/A | 365 days from denial notice | Anthem's COB department can be reached for coverage order disputes. |
| Aetna | N/A | 180 days from denial | Submit primary EOB with the secondary claim. Aetna will not process without it. |
| Cigna | N/A | 180 days from denial | Cigna COB team: 1-800-244-6224 for coverage order questions. |
| Medicare | N/A | 120 days (redetermination at MAC) | Medicare Secondary Payer (MSP) rules apply. Verify MSP status before billing Medicare. |
Related CARC Codes
If you are seeing CO-22, check these related codes: OA-23 (COB processing adjustment), CO-29 (timely filing), CO-44 (subscriber not eligible).
Common Questions About CO-22
What is coordination of benefits?
COB determines which insurance pays first (primary) and which pays second (secondary) when a patient has more than one health plan. The secondary payer processes after receiving the primary's adjudication.
How do I determine primary vs. secondary payer?
Use the birthday rule for dependent children (parent born earlier in the year is primary). For adults, the employer plan is typically primary over COBRA, retiree, or government plans. Medicare has specific MSP rules based on employment status and plan type.
Altair catches CO-22 denials before submission with automated COB verification. See how pre-submit claim scoring works.