Denial Code 22: “This Care May Be Covered by Another Payer” – Simple On-Call Guide (COB)
When working on medical insurance claims, one of the most common denials you may see is:
Denial Code 22: “This care may be covered by another payer per coordination of benefits.”
This usually means the insurance company is saying:
Another insurance is primary, and the claim should be sent there first.
In this blog, we will understand why Denial 22 happens and how to handle it in a simple on-call workflow.
What is Denial Code 22?
Denial 22 = Other payer is primary
This denial occurs when the payer believes the patient has:
• Another active insurance plan
• Another payer that should pay first (primary)
• COB (Coordination of Benefits) is not updated correctly
Why does Denial 22 happen?
Common reasons include:
• Patient has two insurance plans
• Insurance has incorrect COB order
• Primary insurance details are missing
• Primary insurance was active earlier but termed
• Claim was billed to secondary insurance first
Denial Code 22 On-Call Scenario (Step-by-Step)
Step 1: Confirm the denial
Start the call with:
“Claim denied as other payer is primary.”
Then ask:
Step 2: Ask the denial date
Question to rep:
“May I get the denial date?”
Step 3: Ask which insurance is primary
Question to rep:
“Could you please tell me which insurance is the primary insurance?”
Step 4: Does the rep have primary insurance details?
Now there are 2 possibilities:
If YES (rep has primary insurance details)
Ask for policy dates:
1) Effective and termed dates
“What is the effective date and termed date of the policy?”
2) Check if policy was active on DOS
DOS = Date of Service
“Was the policy active on DOS?”
If policy WAS active on DOS
Collect complete insurance details:
Ask:
“What is the policy ID, payer ID, and mailing address of the primary insurance?”
Then finally ask:
“May I have the claim number and call reference number?”
If policy was NOT active on DOS
Ask to reprocess the claim:
“Could you please reprocess the claim since there is no active primary insurance?”
Then ask:
“What is the TAT (Turnaround time)?”
And finally:
“May I have the claim number and call reference number?”
If NO (rep does not have primary insurance details)
Collect details to investigate:
Ask:
“May I have the claim number and call reference number?”
Then request:
“What is the policy ID, payer ID, and mailing address of the primary insurance (if available)?”
Important Notes (Very Useful for On-Call)
1) Check in internal system
If insurance rep does not provide primary insurance details, check:
• Patient file / insurance history
• Payment history
• Any other insurance listed
2) If other insurance is found
If you find another insurance:
Verify eligibility for that insurance
Check if policy active on DOS
Submit the claim to that payer if primary
If policy is inactive:
Release the claim to patient / patient responsibility (based on process)
3) Use payer web portal if available
If you have portal access:
• Search for patient
• Check COB
• Verify eligibility on DOS
Sometimes payer systems show primary insurance details even if reps don’t.
4) If portal shows primary inactive on DOS
Then call payer and request:
“Please reprocess the claim since primary insurance was inactive on DOS.”
5) Update COB in the system
If primary insurance details are confirmed:
• Update that insurance as Primary
• Make current insurance Secondary
• Re-submit claim to primary insurance
What if claim was already paid by primary insurance?
If payer says primary already paid:
Follow Primary EOB (Explanation of Benefits) scenario
(This is a separate workflow.)
Quick Summary (Easy Cheat Sheet)
Denial 22 means: Other payer is primary
Ask for: denial date, primary insurance name
If rep has details: get effective/term dates + active on DOS check
If primary inactive: request reprocess
Always collect: claim # + call ref #
