CO-224: Patient Identification Compromised by Identity Theft
Identity verification is required. Verify the patient's identity with the payer and resubmit.
What Does CO-224 Mean?
With CO (Contractual Obligation), the identity verification requirement is a contractual matter. Work with the payer to verify the patient's identity and resubmit.
CARC 224 indicates that the payer has identified a potential identity theft issue with the patient's insurance information. The patient's identification may have been reported as compromised, flagged for suspicious activity, or involved in known fraud schemes. The payer cannot process the claim until the identity is verified.
This code protects patients from fraudulent use of their insurance information and protects payers from paying fraudulent claims. Resolution requires working with the patient and payer to verify the patient's identity and ensure the claim is legitimate.
Common Causes
| Cause | Frequency |
|---|---|
| Patient's insurance identity has been stolen Someone has used the patient's insurance credentials to submit fraudulent claims, and the payer has flagged the account for identity verification | Most Common |
| Suspicious claim activity detected on patient's account The payer's fraud detection system identified unusual billing patterns suggesting identity theft on the patient's account | Common |
| Patient reported identity theft to the payer The patient notified their insurance company that their identity has been compromised, triggering additional verification requirements | Common |
| Medicare beneficiary identity theft alert CMS or the Medicare contractor has flagged the beneficiary's account due to reported or detected identity theft | Occasional |
How to Resolve
- Contact the payer Determine what identity verification is needed.
- Verify and submit documentation Confirm the patient's identity and submit required documents.
- Resubmit the claim Resubmit once identity is verified.
This claim was denied because the patient's identity has been compromised by identity theft. Complete the payer's identity verification process and resubmit the claim once verification is confirmed. An appeal is not the appropriate resolution.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-224:
| RARC | Description |
|---|---|
| MA130 | Your claim contains incomplete and/or invalid information, and no appeal rights are afforded. Complete the identity verification process and resubmit the claim → |
How to Prevent CO-224
- Verify patient identity with photo ID at each visit
- Cross-reference insurance information against patient demographics
- Report suspected identity theft to the payer immediately
General Prevention
- Verify patient identity at every visit by requesting a photo ID and current insurance card
- Compare patient demographics against insurance records during registration
- Implement identity verification protocols in your patient registration process
- Train staff to recognize signs of potential insurance identity theft
- Respond promptly to payer notifications about identity theft concerns
- Maintain secure handling of patient insurance information to prevent data breaches
Also Filed As
The same CARC 224 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
- https://www.aapc.com/resources/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.