Claims Denying Contractual Obligation (CO)-24: Charges covered under a Capitation Agreement/Managed Care Plan

The most common claim denials are because the patient has a Medicare Advantage (MA) plan. Medicare Advantage is also referred to as Part C Medicare.

These plans manage the patient's Part A and Part B benefits, effectively replacing traditional Medicare. Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Miners Insurance, and other types of third-party payers. If a patient has one of these plans, the claim is not to be billed to Noridian.

If the claim is submitted to Noridian, it will be denied with the following remark code:

  • CO-24: Charges are covered under a capitation agreement/managed care plan.

If you receive a claim denial with this remark code, please verify the patient's eligibility information on the Noridian Medicare Portal (NMP) and submit the claim to the listed HMO or MA plan.

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