This care may be covered by another payer per coordination of benefits

Why this happens on dental claims

• Dual coverage through two working spouses, where the birthday rule or subscriber status determines which dental plan is primary for dependents
• Patients who dropped a prior plan without either payer updating its coordination records, so each points at the other
• Accident-related or surgical dental care where the dental payer expects the medical plan to adjudicate first

How to appeal CO-22

1. Interview the patient or subscriber and document all active coverage with effective and termination dates
2. Determine primacy using the birthday rule for dependents or subscriber status for adults, and have the patient update coordination records with both payers, since many payers only accept updates from the member
3. Submit to the true primary first, then to the secondary with the primary explanation of benefits attached
4. If the denying payer is in fact primary, appeal with documentation of sole coverage or the other plan's termination letter

How to prevent it

• Ask about other dental and medical coverage at every recall visit, not just at intake, and record both plans
• When dual coverage exists, verify primacy before treatment and submit in the correct order the first time