A high denial rate can strain a healthcare practice’s revenue cycle beyond repair. Therefore, preventing these denials is crucial for maintaining a healthy cash flow and reducing administrative burdens.
This guide will discuss everything about the denial code CO 15. We will explain what this denial signifies, common underlying causes, prevention strategies, and steps to resolve it.
So, without further ado, let’s get started!
CO 15 Denial Code – Description
It is one of the Claim Adjustment Reason Codes (CARC) that the payer sends to the provider to explain the reason behind the claim denial. If we specifically talk about the CO 15 denial code, it represents that the denial occurred due to errors in the prior authorization number. That is, the pre-authorization number is either missing, invalid, or incorrect.
For the unversed, the CO in the denial code 15 stands for contractual obligation. It identifies that the denial occurred due to a breach of the payer-provider contract terms.
What Causes the CO 15 Denial Code?
Below are some of the main reasons leading to the CO 15 denial code:
Missing Authorization
The number one cause behind denial code 15 is missing authorization. For instance, you may have submitted the claim without mentioning the required authorization number.
Expired Authorization
You may also receive a denial code CO 15 when you fail to renew the authorization, or it expires before rendering the service.
Invalid Authorization
Another cause that may lead to this denial is providing an invalid authorization number. Simply put, the authorization details do not match the rendered service, date range, or provider mentioned on the medical claim. It could be a typing error or when the authorization applies to another procedure.
Authorization Mismatch
Another reason for the denial code 15 is that the details in the authorization do not align with the billed service.
How to Prevent CO 15 Denial Code?
Here are some strategies that will help you prevent denial code 15 altogether:
Streamline Prior Authorizations with a Checklist
Implement a prior authorization checklist to reduce the likelihood of a denial code 15.
Discussed below are some essential elements of the pre-authorization checklist:
- Authorization number validation.
- Prior authorization requirement check for that CPT code.
- Patient’s current coverage verification.
- Payer authorization request status.
- Service date, which should be within the authorization’s allowed timeframe.
- Supporting documentation.
- Written confirmation receipt.
Do not treat it like a desk reminder. Consider it a systematic workflow to ensure thorough verification before submitting the claim. You should integrate this checklist into your patient intake process and follow it consistently.
Additionally, you should train your front-office, billing, and scheduling staff to follow this checklist. You may also integrate it into your EHR system.
Invest in Staff Training and Accountability
One thing that directly impacts your practice revenue is your billing team’s expertise. No matter what robust system you use, errors will occur with complex authorizations if your staff lacks the needed expertise.
Therefore, you should invest in regular training that covers the following:
- Authorization request management
- Payer approval documentation management
- Mid-year policy change handling
- Payer manual interpretation
- Prior authorization service identification
Additionally, setting up policy update meetings and quarterly refreshers is a great way to keep your team current on the specific payer guidelines. You should emphasize staff accountability by monitoring denials per billing specialist. This insight will also enable you to tailor targeted training programs for all billing staff members and celebrate zero-denial achievements.
Simplify Prior Authorizations with Digital Solutions
Another denial code 15 prevention strategy is to utilize a digital solution for efficient prior authorization management. Here’s how these tools may help:
- Electronic health records (EHR) systems alert you when a specific procedure/service requires prior authorization.
- Payers’ online authorization portals allow you to submit authorization requests electronically.
- You can verify insurance eligibility and acquire authorization at the point of service with real-time payer verification platforms.
- With denial management software, you can monitor the denial code CO 15.
Denial Code 15 – Resolution Guidelines
Luckily, you can resolve and appeal the denial code CO 15! Discussed below are the key steps you should follow if you get this denial:
- The first step should be to review the denial letter carefully. Read it multiple times to understand the reason for the denial and possible solutions.
- The denial code CO 15 highlights issues with the authorization number. Thus, your second step should be to determine the root cause.
- But before spending time investigating authorization issues, take a moment to review the payer contract terms. This vital step will confirm whether the billed service even requires pre-authorization. This step will help you understand whether the billed service needed pre-authorization in the first place. If not, you can appeal the claim and show contract terms as evidence. However, if authorization is required, follow the steps below.
- Check the medical claim you submitted to ensure the authorization number is not missing.
- If an authorization number is present on the claim, carefully cross-check it against all the details in the original authorization letter – ensure the number, dates of service, and approved services match.
- In case of errors, revise the medical claim and resubmit it.
- Finally, diligently follow up with the payer to ensure the timely resolution of the revised or appealed claim. Don’t let it get lost in their system!
Say Goodbye to Denials with NeuraBill
Yes! It is possible. How? We will get into that, but before that, let’s quickly revisit everything we discussed in this comprehensive guide!
First, we explained what the denial code 15 means. It indicates that the payer denied the claim because of an issue with the authorization number included in the submitted claim.
Second, we looked into the common causes leading to this denial.
Since prevention is a strong move against any denials, the next thing that we shared is some preventive strategies. These include streamlining pre-authorization with a checklist, leveraging technology for authorization management, and staff training.
Finally, we discussed the steps to resolve CO 15 denials.
With that said, here’s how you can avoid denials. NeuraBill has a specialized denial management team with extensive industry knowledge. Thus, outsource denial management services to NeuraBill to limit the denial rate to a minimum, ultimately leading to a healthier revenue cycle.
