CO-24: Capitation Agreement Applies
Charges are covered under a capitation agreement or managed care plan. The service is included in the capitated payment the provider already receives.
Why Claims Get Denied with CO-24
Denial code CO-24 is triggered when charges are covered under a capitation agreement or managed care plan. the service is included in the capitated payment the provider already receives. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
Provider is capitated for the service under a managed care contract
Service falls within the scope of the capitation agreement
Claim submitted fee-for-service for a service already covered by capitation
Incorrect billing of services that are part of a global capitation arrangement
How to Appeal CO-24
Review your capitation agreement to confirm whether the service is truly included. If the service falls outside the scope of your capitation arrangement, provide the contract language specifying which services are carved out. If the patient was not assigned to your capitation panel on the date of service, provide panel assignment documentation.
Documentation Required for Appeal
A successful appeal of CO-24 requires thorough documentation. Gather these items before drafting your appeal letter:
Capitation agreement showing scope of covered services
Documentation that the service is carved out of capitation
Panel assignment records for the date of service
Contract language specifying fee-for-service carve-outs
How to Prevent CO-24 Denials
Maintain a clear understanding of which services are capitated versus fee-for-service under each managed care contract. Flag capitated patients in your billing system to prevent fee-for-service claims for covered services. Review capitation agreements annually for scope changes.
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