Covered under a capitation or managed care plan
The patient belongs to a plan that pays a flat monthly amount (capitation) or assigns a different provider group, so this fee-for-service claim is not paid.
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
- Patient enrolled in an HMO or Medicare Advantage plan and you billed traditional Medicare or the wrong plan.
- Patient assigned to a different primary care group under a capitated contract.
- Your group is capitated for this service, so the payment is already in the monthly check.
The fix
Check eligibility for the date of service and find the plan that actually covers the patient. Bill that plan, or confirm the service is inside your capitation. Train the front desk to read the plan name and the primary care assignment on the card.
Appeal or corrected claim?
Redirect the claim. Appeal only when the patient was not enrolled in the capitated plan on that date (attach the eligibility response).
Deadline to watch
The correct payer's timely filing limit from the date of service.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-24 in short
What does CO-24 mean?
The patient belongs to a plan that pays a flat monthly amount (capitation) or assigns a different provider group, so this fee-for-service claim is not paid. The official X12 text reads: "Charges are covered under a capitation agreement/managed care plan."
What usually causes a CO-24 denial?
Patient enrolled in an HMO or Medicare Advantage plan and you billed traditional Medicare or the wrong plan. Patient assigned to a different primary care group under a capitated contract. Your group is capitated for this service, so the payment is already in the monthly check.
How do I fix CO-24?
Check eligibility for the date of service and find the plan that actually covers the patient. Bill that plan, or confirm the service is inside your capitation. Train the front desk to read the plan name and the primary care assignment on the card.
Should I appeal CO-24 or send a corrected claim?
Call or redirect. Redirect the claim. Appeal only when the patient was not enrolled in the capitated plan on that date (attach the eligibility response).
What deadline applies to CO-24?
The correct payer's timely filing limit from the date of service.