PI 22 – This Care May Be Covered by Another Payer Per Coordination of Benefits

The PI-22 denial code indicates that another insurance payer may be responsible for the claim under coordination of benefits (COB) rules. The PI (Payer Initiated) group code identifies an adjustment made by the insurance payer based on claim processing policies.

Providers should verify the patient's insurance information before resubmitting the claim.

Quick Facts

Denial Code
PI-22

Group Code
PI (Payer Initiated)

Category
Coordination of Benefits

Meaning
Another payer may be responsible for the claim

Common Payers
Medicare, Medicaid, and Commercial Insurance

Next Step
Verify the patient's primary and secondary insurance coverage before submitting a corrected claim

What Does PI-22 Mean?

PI-22 indicates that the payer believes another insurance plan should process the claim first.

This often occurs when coordination of benefits information is incomplete, outdated, or inaccurate.

Providers should determine the correct order of benefits before taking additional action.

Common Causes

Providers may receive the PI-22 denial code when:

• The wrong insurance payer was billed first.

• Coordination of benefits has not been updated.

• The patient has multiple insurance plans.

• Medicare Secondary Payer rules apply.

• Insurance information is outdated.

How To Resolve PI-22

If you receive the PI-22 denial code:

• Verify all active insurance coverage.

• Determine the correct primary payer.

• Update coordination of benefits information.

• Submit the claim to the appropriate payer.

• Resubmit the claim if necessary.

Common Billing Mistakes

Common issues associated with PI-22 include:

• Billing the secondary payer first.

• Outdated insurance records.

• Missing coordination of benefits information.

• Failure to verify insurance eligibility.

• Incorrect payer selection.

Frequently Asked Questions

What is coordination of benefits?

Coordination of benefits determines which insurance plan pays first when a patient has more than one active policy.

Should providers bill another payer first?

If another insurance plan is primary, providers should submit the claim to that payer before billing the secondary plan.

Can incorrect insurance information trigger PI-22?

Yes. Outdated or inaccurate insurance information is a common reason for PI-22 denials.

How can providers prevent PI-22 denials?

Verify insurance coverage and coordination of benefits before every patient visit.

Related PI Codes

You may also encounter:

• PI-204 Denial Code

• PI-16 Denial Code

• PI-96 Denial Code

• PI-197 Denial Code

Quick Summary

The PI-22 denial code indicates that another insurance payer may be responsible for processing the claim. Verifying coordination of benefits and billing the correct payer can help resolve the denial and prevent future claim delays.