Denial Code CO-119: Causes, Solutions, and Prevention

Denial Code CO-119 is a frequent issue in medical billing that can disrupt the cash flow of your physical therapy practice. This denial code can be particularly frustrating because it often relates to authorization issues that could have been avoided with proactive measures. In this blog, we’ll explore what CO-119 means, why it matters, and how to address and prevent it effectively.

What is Denial Code CO-119?

Denial Code CO-119 indicates that the claim has been denied because the service requires prior authorization, which was either not obtained or not correctly documented. This means the payer is refusing to reimburse the claim because the necessary approval for the service was not verified in advance.

Why Does CO-119 Matter?

CO-119 denials can lead to significant revenue loss and increased administrative workload. These denials often stem from overlooked steps in the pre-authorization process, which can frustrate both providers and patients. Addressing CO-119 denials promptly is crucial to ensuring that your practice receives the payments it deserves and maintains smooth operations.

Deconstructing a CO-119 Denial: What Went Wrong and How to Fix It?

Example:

• Initial Billing:
  • CPT 97110: Therapeutic Exercise
  • CPT 97140: Manual Therapy
• Outcome: Both services were denied under CO-119 because prior authorization was not on file with the payer.

Remedy:

1. Check Authorization Requirements: Review the payer’s policies to confirm if the services require prior authorization.
2. Obtain Retroactive Authorization: Contact the payer to request retroactive authorization for the services rendered, if allowed.
3. Resubmit or Appeal: Resubmit the claim with the obtained authorization details, or appeal the denial with documentation supporting the retroactive authorization request.

• Corrected Billing:
  • Submit the claim with the authorization reference number included, ensuring the payer recognizes the services as authorized.

Actionable Steps: How to Address a CO-119 Denial

1. Review the Explanation of Benefits (EOB): Verify the specific reason for the denial and confirm whether prior authorization was required and missing.
2. Contact the Payer: Reach out to the payer to clarify their authorization requirements and explore the possibility of obtaining retroactive approval.
3. Gather Documentation: Collect any relevant documentation, such as clinical notes or communication records, that supports the necessity of the services provided.
4. Resubmit or Appeal: Correct the claim with the proper authorization details or file an appeal with the supporting documentation.

Common Causes of CO-119 Denials

1. Missing Prior Authorization: The service provided required pre-approval, which was not obtained or not properly documented.
2. Incorrect Authorization Details: Errors in the authorization information, such as mismatched dates of service or incorrect CPT codes.
3. Lack of Awareness of Payer Policies: Failure to stay updated with the payer’s latest authorization requirements and changes.

Proactive Prevention: Avoiding CO-119 Denials

Pre-Claim Submission Checklist:

• Verify Authorization Requirements: Before scheduling services, confirm whether prior authorization is needed by consulting the payer’s guidelines.
• Obtain and Document Authorizations: Secure the necessary authorizations and ensure that all relevant details are accurately documented in your billing system.
• Double-check for Accuracy: Verify that the authorization details, including service dates and CPT codes, match the submitted claim.

Training and Best Practices:

• Train your front office and billing staff on payer-specific authorization requirements to ensure compliance.
• Implement a checklist or protocol for verifying authorizations before patient appointments.

Technology and Tools:

• Utilize practice management software with authorization tracking capabilities to streamline the authorization process.
• Leverage automated reminders to prompt staff to verify authorizations before submitting claims.

Conclusion: Protect Your Practice’s Revenue with Expert Denial Management

Denial Code CO-119 can pose a significant challenge to maintaining a steady revenue stream, but with the right strategies, it can be effectively managed. By ensuring all necessary authorizations are obtained and accurately documented, you can minimize the risk of denials and focus on providing quality care to your patients.

Take Action with SPRY

Navigating authorization requirements and managing denials like CO-119 doesn’t have to be overwhelming. SPRY’s advanced physical therapy software simplifies the billing process, tracks authorizations, and helps prevent CO-119 denials before they occur. Schedule a demo today to learn how SPRY can help streamline your practice’s billing and revenue cycle management.

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