Work-related injury: bill workers' compensation
The payer believes the injury or illness happened at work, so the workers' compensation carrier should pay.
CO = Contractual Obligation. The provider owes the difference. The patient cannot be billed for this amount. The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- The patient reported a work injury at intake or the diagnosis suggests one.
- An open workers' compensation case in the payer's file, even for an unrelated visit.
The fix
Ask the patient about the injury. If it is work related, bill the workers' compensation carrier with the claim number and employer details. If it is not, get a written statement from the patient or employer and ask the health plan to reprocess.
Appeal or corrected claim?
Not an appeal: either redirect the claim to the right payer or ask the health plan to reprocess with proof the visit was not work related.
Deadline to watch
Workers' compensation filing limits vary by state and are often short. The health plan's timely filing clock keeps running while you sort it out.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-19 in short
What does CO-19 mean?
The payer believes the injury or illness happened at work, so the workers' compensation carrier should pay. The official X12 text reads: "This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier."
What usually causes a CO-19 denial?
The patient reported a work injury at intake or the diagnosis suggests one. An open workers' compensation case in the payer's file, even for an unrelated visit.
How do I fix CO-19?
Ask the patient about the injury. If it is work related, bill the workers' compensation carrier with the claim number and employer details. If it is not, get a written statement from the patient or employer and ask the health plan to reprocess.
Should I appeal CO-19 or send a corrected claim?
Call or redirect. Not an appeal: either redirect the claim to the right payer or ask the health plan to reprocess with proof the visit was not work related.
What deadline applies to CO-19?
Workers' compensation filing limits vary by state and are often short. The health plan's timely filing clock keeps running while you sort it out.