Healthcare Error Code
Healthcare Insurance / Medical Billing
Claim Adjustment Reason Codes (CARC)
CO-109 | Claim not covered by this payer
Industry
Healthcare
Canonical
/healthcare/error-codes/co-109/
Last Updated
Feb 25, 2026
Summary
This code indicates that the payer is not responsible for covering the submitted claim.
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What This Code Means
CO-109 is used when the insurer determines it is not the correct payer for the claim. Coverage may exist under another insurer or plan. This is a payer responsibility determination, not a service denial. The claim itself may be valid but directed to the wrong payer. It does not imply improper billing.
Where Users Usually See This Code
- Remittance advice
- EOB statements
- Claim status portals
Why This Code Appears
- Incorrect payer information submitted
- Coordination of benefits issues
- Coverage terminated or changed
What Typically Happens Next
- The claim is denied by the payer
- Responsibility shifts to another insurer
- The claim may need redirection
What This Code Is Not
- It is not a non-covered service
- It is not a billing format error
- It is not patient responsibility by default
Troubleshooting Checklist
- □ Verify primary coverage
- □ Review coordination of benefits
- □ Confirm active policy status
Notes And Edge Cases
Dual coverage situations often trigger this code. Timing of coverage updates can cause temporary payer mismatches.
Related Codes
8 links
- CO-22 CodeCare may be covered by another payer
- CO-27 CodeCoverage terminated
- CO-204 CodeService not covered under plan
- CO-61 CodeProcedure not covered for age
- CO-62 CodeNot covered for place of service
- CO-200 CodeNon-covered service
- CO-50 CodeNon-covered services
- CO-54 CodeMultiple physicians not allowed
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