CARC 22: This Care May Be Covered by Another Payer per Coordination of Benefits

What it means

The payer is saying that based on the information they have, another insurance plan may be primary or responsible for this claim. This usually happens when the payer's records show other coverage on file, or the claim indicates there may be another payer involved (such as through COB data, accident indicators, or patient-reported insurance changes).

Common causes

Patient has other active insurance coverage that was not billed first
Payer's COB (coordination of benefits) records are outdated or incorrect
Patient recently changed jobs, married, divorced, or became eligible for Medicare, triggering a new COB order
Claim indicates an accident, work injury, or other situation suggesting a different payer (e.g., auto or workers' comp) should be billed first
Patient failed to update the payer with current COB information
Secondary or tertiary payer was billed before the primary payer

How to fix it

Contact the patient to confirm current insurance coverage, including any other active policies
Verify the correct order of payers (primary, secondary, tertiary) based on COB rules
If another payer is confirmed as primary, submit the claim to that payer first and attach their EOB when billing the original payer as secondary
If the payer's COB information is outdated, have the patient contact the payer directly to update their COB file
Resubmit the claim once the correct payer sequence is established and the primary payer has processed it
Check if the claim involves an accident or injury; if so, confirm whether auto, liability, or workers' comp coverage applies first

Appeal / resubmit

If you have verified that this payer is actually primary (not secondary) and no other coverage applies, submit an appeal with documentation showing the patient's current coverage status, such as a signed COB attestation, termination notice from another payer, or eligibility verification results. Include any prior correspondence with the payer's COB department if the issue stems from outdated records.

Related codes

Frequently asked

Does this mean the claim was denied permanently?

Not necessarily. It often means the payer needs updated coordination of benefits information before they can process the claim correctly.

What if the patient says they have no other insurance?

Have the patient contact the payer directly to update their COB records, since the payer's system may still show outdated coverage information.

Should I bill the other payer first?

If COB rules indicate another payer is primary, yes—bill that payer first and then submit this claim as secondary with the primary payer's EOB attached.

More free billing tools: all denial codes · denial lookup · Medicare fee calculator

This content is for informational purposes only and does not constitute billing or legal advice. Always verify requirements with the specific payer and applicable regulations.