If you work in medical billing, you may have encountered the denial code CO-15. This code indicates that the claim was denied because the authorization number was missing, invalid, or did not apply to the billed services or provider. In this article, we will explain what this code means, why it happens, and how to prevent it from affecting your revenue cycle.
What is an Authorization Number?
An authorization number is a unique code that is assigned by the insurance company to approve certain services or procedures that require prior authorization. Prior authorization is a process where the provider has to obtain approval from the insurance company before rendering the services to the patient. This is done to ensure that the services are medically necessary, appropriate, and covered by the patient’s plan.
An authorization number is usually obtained by calling or faxing the insurance company or using an online portal. The provider has to provide information such as the patient’s name, date of birth, insurance ID number, diagnosis code, procedure code, date of service, place of service, and estimated charges. The insurance company will then review the request and either approve or deny it. If approved, the provider will receive an authorization number that has to be entered on the claim form in block 23.
Why does CO-15 denial code happen?
There are several reasons why a claim may be denied with CO-15 denial code. Some of them are:
- The provider forgot to obtain prior authorization for the service or procedure.
- The provider obtained prior authorization but did not enter the authorization number on the claim form or entered it incorrectly.
- The provider entered an expired or invalid authorization number on the claim form.
- The provider entered an authorization number that did not match the service or procedure billed.
- The provider entered an authorization number that did not apply to their provider type or specialty.
- The service or procedure did not require prior authorization but the provider entered an authorization number anyway.
How to Avoid CO-15 Denial Code?
To avoid CO-15 denial code and ensure timely and accurate reimbursement, providers should follow these best practices:
- Check with the insurance company if prior authorization is required for the service or procedure before rendering it to the patient. You can use online tools such as CPT Code Lookup or payer websites to verify this information.
- Obtain prior authorization from the insurance company as soon as possible and document it in the patient’s record. Keep a copy of the approval letter or confirmation number for reference.
- Enter the correct and valid authorization number on the claim form in block 23. Make sure it matches the service or procedure billed and applies to your provider type or specialty.
- Do not enter an authorization number if the service or procedure does not require prior authorization. This may cause confusion and delay in processing your claim.
- If you encounter an emergency situation where you cannot obtain prior authorization before rendering the service or procedure, contact the insurance company as soon as possible after the fact and explain the situation. You may be able to get retroactive approval if you can justify the medical necessity and urgency of the service or procedure.
CO-15 denial code is one of the common denial codes in medical billing that can affect your cash flow and revenue cycle. By understanding what it means and how to avoid it, you can reduce your claim rejections and denials and improve your reimbursement rate. If you need help with resolving CO-15 denial code or any other denial codes, you can contact us . We are a professional medical billing company that can help you with all your billing needs.