CO-100: Payer sent payment to the patient

Mechanically, the claims system flags that the check or EFT went to a different payee, then marks your claim line with CO-100 instead of paying you. Since it is a CO code, the unpaid amount is not considered patient responsibility and is treated as a contractual adjustment unless you can get the payer to reissue payment to you.

The cash impact is real: 30 to 90 days of extra A/R while you chase patients for checks, and in some states you may be barred from balance billing certain emergency or mandated benefits. If you cannot get the payer to redirect payment, you often end up writing off high per diem or session rates as contractual or uncollectable.

• Confirm on the remit and in the payer portal that payment was issued and verify the payee name and address.
• Check the patient file for a signed assignment of benefits and financial agreement that clearly designates your facility as payee.
• Call the payer to request redirection of payment to your facility, citing the assignment of benefits and asking if they can void the member payment and reissue to you.
• If the payer requires it, submit an appeal with a copy of the assignment of benefits, proof of services rendered, and a request to reprocess payment to your TIN and pay-to address.
• If the payer will not redirect, contact the patient or guarantor, explain that their plan paid them, and arrange for endorsement or repayment to your facility with clear documentation.
• After resolution, adjust the account accurately in your PMS, posting any payer reissue or patient payment and writing off any amount that cannot be collected under contract or law.

• Collect a clear assignment of benefits and financial responsibility agreement at admission for all levels of care, especially out-of-network programs.
• During verification of benefits, ask specifically whether the plan pays the provider or the member for out-of-network behavioral health services and document the response.
• Configure registration and billing workflows so that pay-to information, NPIs, and assignment indicators are consistent and accurate on every UB-04 and CMS-1500.
• Flag payers and plans that commonly pay members directly, and train front office staff to discuss this with patients and set expectations for turning over checks promptly.