CO-214 denial code
Workers compensation claim adjudicated as non-compensable
How to fix it
Bill the patient's health plan, noting the workers compensation denial.
How to prevent it
Obtain the compensability determination before billing; carriers deny compensability more often than expected.
In practice
A patient is treated for a back injury they attribute to lifting at work. The workers compensation carrier investigates and denies compensability, and the claim returns CO-214.
The carrier has decided the injury is not work-related, which removes it from the workers compensation system entirely. That determination governs whether the carrier pays, not whether the injury was real.
Bill the patient's health plan, attaching the compensability denial. Health plans commonly exclude work-related injuries and will want the denial as evidence that the exclusion does not apply.
What sits behind it
Compensability disputes are more frequent than most practices expect, particularly for cumulative trauma, back injuries and conditions with a plausible non-work explanation. The determination can also be appealed by the patient through the state system, which can reverse it months later.
That possibility of reversal is why documentation matters. Where the patient successfully appeals, the workers compensation carrier becomes liable retroactively, and a practice that has already collected from the health plan will be reconciling two payers.
The filing deadline with the health plan runs from the date of service throughout the compensability dispute, which frequently takes months. Billing the health plan in parallel rather than sequentially is what protects against a timeliness denial on top of the coverage question.
Related codes
Terms used here — Coordination of Benefits · Timely Filing · Denial
How we handle it — AR Management · Denial Management · Patient Collections
Primary sources
The rules behind CO-214, at the bodies that publish them.
- Workers' compensation medical billing (opens in a new tab)
US Department of Labor, OWCP — Federal workers' compensation fee schedule and billing requirements. State programs differ, but the structural rules are the same: a separate payer with its own schedule.
- Medicare Secondary Payer Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — When Medicare pays second, and to whom the claim goes first. Coordination-of-benefits denials are resolved here rather than with the patient.
- Medicare Claims Processing Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — The operative manual for how Medicare claims must be coded, submitted, adjusted and appealed. When a payer policy and a vendor's advice disagree, this settles it.
Looking for a different code? Search all 190 CARC and RARC codes
Questions about CO-214
The compensability denial from the workers compensation carrier. Health plans commonly exclude work-related injuries, so they will want documentary evidence that the exclusion does not apply before accepting the claim.
Yes. Patients can appeal through the state workers compensation system, and reversals happen months later. Where that occurs the carrier becomes liable retroactively, so keep the documentation and expect to reconcile if the health plan has already paid.
No. The health plan's filing deadline runs from the date of service throughout a dispute that often takes months, so billing in parallel protects against adding a timeliness denial to an already contested account.
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