For healthcare providers, CO15 denials create unnecessary payment delays when claims are rejected due to authorization issues. These denials typically occur when prior authorization numbers are missing, invalid, or mismatched – but with proper systems, they’re completely preventable.
Understanding CO15 Denials
This denial triggers when:
➔ No authorization was obtained
➔ An invalid authorization number was used
➔ Authorization details don’t match the claim
Top 5 Causes
- Missing Authorizations
- Services requiring pre-approval weren’t authorized
- Emergency exceptions are not properly documented
- Data Entry Errors
- Typos in authorization numbers
- Incorrect dates or procedure codes
- Authorization Mismatches
- The wrong provider is listed on the authorization
- Service location not covered
- The procedure does not match the approval
- Expired Approvals
- Using outdated authorization numbers
- Time-limited approvals not renewed
- System Failures
- EHR not flagging authorization requirements
- Interface errors with payer systems
5-Step Prevention System
1. Implement Authorization Tracking
- Create a centralized authorization database
- Set expiration alerts (30/15/5 days out)
- Color-code by approval status
2. Enhance Verification Processes
- Double-check authorization details before service
- Verify:
- Approved procedures
- Date ranges
- Provider credentials
3. Optimize Technology
- Use practice management software with:
- Authorization requirement alerts
- Auto-population of auth numbers
- Real-time eligibility checks
4. Train Your Team
- Monthly workshops on:
- Payer-specific authorization rules
- Proper documentation practices
- Common denial triggers
5. Conduct Pre-Submission Audits
- Review 10% of claims before filing
- Confirm authorization numbers are:
- Present
- Valid
- Matched to services
When CO15 Denials Happen
- Investigate immediately (within 24 hours)
- Determine Root Cause:
- Missing authorization?
- Data entry error?
- Expired approval?
- Take Corrective Action:
- Obtain retroactive authorization if possible
- Correct and resubmit the claim
- Appeal with supporting documentation
Claims Med: Your CO15 Denial Solution
Stop losing revenue to authorization denials. Our specialists help:
- Reduce CO15 denials by 85-95%
- Implement automated authorization tracking
- Train staff on prevention best practices
- Recover lost payments from past denials
Get expert assistance today:
📞 Call (713) 893-4773 | 📧 Email info@claimsmed.com