Denial Codes - Healthcare

CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete

Channagangaiah

Insurance will be denying the claim as CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete, whenever the claim submitted with the inadequate information to insurance company for reimbursement

Example:

Assume provider has billed the claim to insurance company for patient John. Insurance adjudicates and found they need student info from patient john for adjudicating and reimbursing the claim, hence they denied the claim with denial Code CO 17.

Once the provider receives the denial EOB, he needs to see whether the information is requested from patient or provider. In this example they requested information from the patient (Insurance also send letter to patient requesting information needs to be updated), in this case provider needs to wait until the patient updates the requested information directly to insurance company.

Note: Future claims submitted to this patient will also be denied with the same reason, if patient has not updated the requested information to insurance company.

Follow the below steps in order to resolve the denial code CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete:
  • First step is to verify, whether the requested information by insurance company is from healthcare provider or it is from the patient?

If the information is requested from the patient, then follow the below steps:

  • Review Explanation of Benefits/Electronic Remittance Advice to determine the exact information that is required by carrier from patient for processing the claim. Information may be COB/Accident Info/Student Info/other info etc.
  • If not available, reach out insurance company to get the exact information they required from patient and check when the last letter was sent to the patient requesting for that information. Request them to send another letter to patient if still patient has not updated.
  • If previous notes already states, patient has already updated. Reach out insurance company and reprocess all the pending claims.
  • If patient has not updated the requested information after several letter, please bill or contact the patient to update the requested information with insurance immediately (Before contacting or billing, please check the client specification and take the necessary action).

If insurance company requested the information from provider, then follow the below steps:

  • Review Explanation of Benefits/Electronic Remittance Advice to determine the exact information that is required by insurance company from provider for processing the claim. If the information not available, call the claims department of insurance company to get the exact information they required from provider in order to reimburse the claim.
  • Resubmit the claim with requested information in order to reprocess the claim towards payment.
  • If required information is not available in application, contact provider on the same for further action.
Call the claims department and ask the following questions to resolve the CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete:
  • May I know the Claim denied or pended date?
  • Find out what information they required and from whom is it from patient or from provider?
  • If it is from patient, get the date of last request sent and how many times the letter sent to patient? (If patient has already updated the requested information to insurance company, send the claim back for reprocessing).
  • If the information requested from provider, get an address or fax number to which the requested information to be mailed or faxed? (Resubmit the claim through fax or mail along with requested information).
  • Get the appeal information, if claims need to be appealed?