CARC 22: May be covered by another payer (coordination of benefits)

Group code context

Often sent with group code CO or OA.

Common causes

• Patient has other insurance the payer knows about
• Coordination of benefits questionnaire not answered by the patient
• Medicare secondary payer situation

Step-by-step fix

1. Ask the patient about other coverage
2. If another plan is primary, bill it first, then bill this payer with the primary EOB
3. If there is no other coverage, ask the patient to update COB with the payer, then resubmit

Appeal guidance

Appeal only after the COB record is fixed and the payer still denies.

When not to appeal

Do not appeal while the COB record is still wrong. The patient usually has to call the payer.

Prevention checklist

• Ask about all coverage at every visit
• Use the Medicare secondary payer questionnaire for Medicare patients

Related codes

CARC 23: Impact of the prior payer’s payment or adjustment

CARC 109: Not covered by this payer, send to the correct payer

Source and review

Last checked: 2026-10-05