Insurance company will deny the claim with CO 19 denial code – This is a work related injury/illness and thus the liability of the Worker’s Compensation Carrier, when the services pertain to work related injury and should be submitted to workers compensation carrier.
What is Workers Compensation?
Workers compensation insurance covers the medical benefits and wages to employees for work related injuries or illness.
Features of Workers Compensation Program:
- This plan covers only the diseases, infections or injuries that are work related
- No patient’s responsibility.
- Employer pays the premium as well as the annual deductible amount.
- No coverage for dependents.
Reports to be submitted for Workers compensation:
- Accident Report
- First Investigation Report
- Medical Records
- Witness Reports
- Employers Reports
- Ombudsman’s Reports
When claim denied CO 19 denial code – we need to first check the below steps to resolve the issue:
- First see is there a claim number available in place of insurance ID.
- Review other DOS with same Procedure/Diagnosis code to determine if they were processed as medical or injury related.
- Review patient medical records to determine if the service pertains to injury.
- Was the claim submitted to correct Payer?
- Review is there any note stating this is under litigation?
- If the claim Worker Comp/Auto accident related, update the appropriate details and submit the claim with medical records (Important Note: Resubmit all open claims of this patient with same CPT/DX combination to worker compensation carrier).
- If not available, then patient needs to be contacted for correct information.
Call the claim department and ask the following questions when claim denied with CO 19 denial code – This is a work related injury/illness and thus the liability of the Worker’s Compensation Carrier:
- Get the received date and the date they have denied the claim?
- Review the diagnosis code and Medical records to ascertain that its work related injury or not?
- If you come across the claim billed is work related injury/illness, then update the worker compensation carrier details and submit the claim.
- If the claim billed is not work related injury/illness and if rep refused to send the claim back for reprocessing, take appeal limit, address or fax# (Appeal the claim with medical records).