CO-24 denial code: charges are covered under a capitation agreement or managed care plan

CO-24 means the patient's benefits for this service are covered under a capitation arrangement or a managed-care entity, so the billed payer is not the one that pays. It is a coordination/routing denial: the claim usually belongs with the capitated medical group, IPA, or managed-care plan. It becomes an appeal only when the patient was not actually enrolled in that arrangement on the date of service.

What CO-24 means

Under capitation, a medical group or IPA receives a fixed per-member payment and becomes responsible for covered services — so the underlying payer denies fee-for-service claims as CO-24. The fix is identifying and billing the responsible capitated entity.

Why CO-24 fires

• The patient is enrolled in a managed-care or capitated plan that holds payment responsibility.
• The service falls under the capitated medical group's or IPA's scope.
• The claim was sent to the health plan when it should have gone to the delegated entity.
• Enrollment records are outdated and the patient was not actually capitated on the date of service.

Is CO-24 worth appealing?

How to resolve or appeal CO-24

1. 1

   Identify the responsible entity

   Determine the capitated medical group, IPA, or managed-care plan that holds risk for the member and submit the claim to them.

2. 2

   Confirm enrollment on the date of service

   If the patient was not actually in the capitated arrangement that day, that is the basis to dispute CO-24 with the original payer.

3. 3

   Check delegation rules

   Some services carve out of capitation. Verify whether the specific service was the plan's responsibility rather than the delegated group's.

CO-24 — frequently asked

Reason-code meanings are paraphrased from the X12 Claim Adjustment Reason Code list for plain-language reference; they are not reproduced verbatim. This is general information, not legal, coding, or medical advice — always confirm against the payer's remittance and policy.