835 Denial Combination
CO-22
Contractual Obligation · Claim-Level Adjustment
What This Combination Means
This service is covered under the patient's capitation agreement or managed care contract. The service is included in the capitation payment and cannot be billed separately.
N/A
Appeal Success
7-14 days
Avg. Resolution
Medium
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-22 combination — not generic advice.
- 1
Verify the patient's plan type — HMO capitation plans have specific carve-outs for covered services.
- 2
Confirm the procedure is included in the capitation agreement and not a carve-out service.
- 3
If included in capitation, post the adjustment; the service is covered through the monthly capitation payment.
- 4
If the service should be a carve-out (not capitated), appeal with your capitation contract language.
Specialty Context
How CO-22 typically presents across different practice types.
Dental
Verify this service is covered under the patient's capitation agreement or managed care contract per your dental plan contract and documentation requirements.
Medical
Confirm this service is covered under the patient's capitation agreement or managed care contract against payer policy and submit corrected claim as needed.
Behavioral Health
Apply behavioral health parity rules and confirm this service is covered under the patient's capitation agreement or managed care contract per MHPAEA standards.
Individual Code References
View the standalone definition for each code in this combination.
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