Denial Codes - Healthcare

CO 20 and CO 21 Denial Code

Channagangaiah
CO 20 Denial Code – This injury/illness is covered by the liability carrier:

Insurance will deny the claim with CO 20 Denial Code – This injury/illness is covered by the liability carrier, when the healthcare claim billed is responsibility of the liability insurance.

CO 21 Denial Code – This injury/illness is the liability of the no-fault carrier:

In the same way insurance will deny the claim with CO 21 Denial Code – This injury/illness is the liability of the no-fault carrier, when the healthcare claim billed is responsibility of the no-fault insurance.

Now let us understand the meaning of Liability and no fault carrier in order to understand the denial code CO 20 and CO 21.

What is the definition of Liability carrier and No-fault carrier?

The major kind of liability insurance that can be quoted under this class is the MOTOR VEHICLE ACCIDENT PLANS (MVA).

They are mainly State Owned Policies and the claims supposed to be submitted with various bills or documents and they are as follows:

  1. Accident Report from the patient.
  2. FIR or First Injury Report from the Police
  3. Medical Records from the provider and
  4. Witness reports from the witnesses.

The various types of MVA coverage are:

  1. Coverage for Self, Family and Designated Driver:
  • PIP (Personal Injury Protection): This coverage pays for the medical bills of the policy holder, dependents and designated drivers.
  • Collision Coverage: This coverage pays for the damage caused due to road accident.
  • Comprehensive Coverage: This coverage pays for the damage caused to the car due to a reason other than a road accident, for e.g. like a natural disaster.
  1. Coverage for Third Party:
  • Bodily Injury Liability (BIL): This coverage pays for the medical bills of the third party.
  • Property Damage Liability (PDL): This coverage pays for the damage caused to the third party’s property.
  • Uninsured: This plan pays if the other party who is involved in an accident escapes or does not have an auto insurance coverage. This plan will pay for both the medical bills as well as the damages caused.
  • Under Insured: This plan pays when the other parties’ policy maximum has been met.
  • No Fault Clause/ State: If the state government announces a State as no-fault State, then the policy holder’s auto insurance coverage pays for both the medical and damage bills, irrespective of whose fault it is.
When claim denied CO 20 and CO 21 denial code – we need to first follow the below steps to resolve the issue:
  • Review other Date of service with same CPT/DX code to conclude if they were processed as medical or injury related.
  • Review patient documentation to ascertain if the healthcare service pertains to injury.
  • If claim submitted is injury related and coverage of liability insurance or no fault carrier, update the appropriate details and submit the claim along with medical records.
  • If the liability carrier or no fault carrier information not available, then check with patient to update the required information.