CO-109Contractual ObligationEligibility
CO-109 Denial Code: Claim not covered by this payer/contractor
The claim or service is not covered by this payer/contractor and must be sent to the correct payer.
Why CO-109 happens
- ●Claim sent to the wrong payer or wrong plan within a payer family
- ●Member's plan is administered by a different entity (e.g., carve-out)
- ●Medicare Advantage claim sent to traditional Medicare
How to fix a CO-109 denial
- 1
Identify the correct payer from the member ID card and eligibility response
- 2
Submit to the correct payer with original filing proof if near timely limits
How to prevent it
Verify payer/plan and payer ID from the eligibility response, not just the card.
Drowning in CO-109 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.