CO-255: Property & Casualty Claim Pending Litigation
The disposition of the related Property & Casualty claim is pending due to litigation. Payment is held because the associated liability or P&C claim is in litigation.
Why Claims Get Denied with CO-255
Denial code CO-255 is triggered when the disposition of the related property & casualty claim is pending due to litigation. payment is held because the associated liability or p&c claim is in litigation. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
Auto accident claim in litigation with the liability insurer
Workers' compensation claim under legal dispute
Personal injury claim pending resolution
Subrogation hold due to ongoing litigation
How to Appeal CO-255
Provide the current status of the litigation and any available settlement information. If the health plan should process the claim regardless of the P&C litigation (e.g., coordination of benefits), provide documentation showing the health plan's primary obligation. Consult with the patient's attorney regarding expected resolution timeline.
Documentation Required for Appeal
A successful appeal of CO-255 requires thorough documentation. Gather these items before drafting your appeal letter:
Litigation status update from the patient or attorney
Coordination of benefits documentation
Primary insurer determination documentation
Settlement information (if available)
How to Prevent CO-255 Denials
Identify accident-related and liability claims during patient intake. Coordinate with the patient and their attorney on billing expectations. Track litigation status for claims on hold.
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