215Denial Code (CARC)Active
CO 215 Denial Code - Subrogation Settlement Explained
Code 215 indicates that the claim adjustment or denial is due to a subrogation claim from a third party settlement. This typically means another insurer or entity has taken responsibility for the payment, often due to a situation like an accident settlement.
Who Pays: Group Code Liability
For code 215, the group code CO is used, reflecting that this is a contractual write-off. The provider must absorb the adjustment, and the patient cannot be billed for this amount.
Why Claims Get Code 215
- The patient's insurance policy involves a third-party settlement due to an accident.
- A liability insurer has taken charge of the payment due to a legal settlement.
- The primary insurance has coordinated benefits with a third-party payer.
- The patient reported an accident or injury settlement to their insurance.
- A payer identified another responsible party post-claim submission.
How to Fix & Resubmit
- Verify the patient's insurance details to confirm the presence of a third-party payer.
- Contact the payer to obtain documentation on the subrogation settlement details.
- Check if the patient has any liability insurance that should be primary.
- Update the claim with correct coordination of benefits information if needed.
- Submit a corrected claim if the original submission did not reflect the third-party liability.
Corrected Claim or Appeal?
For code 215, a corrected claim is appropriate if the original submission failed to acknowledge third-party liability. An appeal is unlikely to succeed unless supported by new or corrected information.
Preventing Future 215 Denials
- Verify all insurance coverages at the time of registration, including potential third-party payers.
- Ask patients about any recent accidents or legal settlements that might affect coverage.
- Regularly update coordination of benefits information.
- Train staff to recognize situations that may involve third-party liability.