CO 24: Covered Under Capitation
The patient is in a capitated or managed-care plan, so this is paid under that contract.
Rebill the managed-care plan that holds the contract. Verify the plan before you resubmit.
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What CO 24 means
CO: Contractual obligation. The provider absorbs it and cannot bill the patient.
So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
Is It Worth Appealing?
Fix and resubmit. This is a correction, not an appeal. Appealing burns the deadline.
Why It Fires
In the order we see it.
The patient has a Medicare Advantage plan and the claim went to traditional Medicare.
The service falls under a capitation arrangement rather than fee-for-service.
How to Fix CO 24, Step by Step
Rebill the managed-care plan that holds the contract. Verify the plan before you resubmit.
- 1Step 1: Read the remark code. Find the remark code printed next to CO 24 on the 835 or EOB. It says what the payer wants back.
- 2Step 2: Find the cause. Match the denial to one of the 2 causes in Why It Fires above, and fix that one.
- 3Step 3: Do this. Rebill the managed-care plan that holds the contract. Verify the plan before you resubmit.
- 4Step 4: Attach the documentation. Current eligibility showing which plan holds the contract on the date of service.
The common mistake. Do not appeal to the payer that denied it. They are telling you they are not the payer. Find the right one and watch the new filing window.
Free: the Denial Code Appeal Playbook. 53 codes on one sheet: appeal, fix and resubmit, or let it go, and what to attach. Get the playbook
CO 24 description
The patient is in a capitated or managed-care plan, so this is paid under that contract.
The patient is in a capitated or managed-care plan, so this is paid under that contract. So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
This is our plain-English wording, not the official X12 text. X12 asserts copyright over the published descriptions, so we write our own and say what it means for the money rather than restating the code.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
Related Codes
CO 185
The rendering provider is not eligible to perform the service billed.
Read the CO 185 pageCO 242
The provider was out of network, or not the patient's assigned primary care provider.
Read the CO 242 pageCO 27
Coverage had ended on the date of service.
Read the CO 27 pageCO 26
Service fell before coverage started.
Read the CO 26 page
Your Questions Answered
What does CO 24 mean?
The patient is in a capitated or managed-care plan, so this is paid under that contract. Contractual obligation. The provider absorbs it and cannot bill the patient.
Can you appeal CO 24?
Fix and resubmit. Rebill the managed-care plan that holds the contract. Verify the plan before you resubmit.
Why does CO 24 happen?
The patient has a Medicare Advantage plan and the claim went to traditional Medicare. The service falls under a capitation arrangement rather than fee-for-service.
What documentation wins a CO 24 appeal?
Current eligibility showing which plan holds the contract on the date of service.
How do I fix a CO 24 denial?
Step 1: Read the remark code. Find the remark code printed next to CO 24 on the 835 or EOB. It says what the payer wants back. Step 2: Find the cause. Match the denial to one cause: The patient has a Medicare Advantage plan and the claim went to traditional Medicare. The service falls under a capitation arrangement rather than fee-for-service. Step 3: Do this. Rebill the managed-care plan that holds the contract. Verify the plan before you resubmit. Step 4: Attach the documentation. Current eligibility showing which plan holds the contract on the date of service.
Most searched: CO 97 · CO 96 · OA 23 · PR 204 · CO 109 · CO 197 · CO 45 · CO 50
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