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CO-215 Denial Code: Subrogation of Third-Party Settlement

CO-215 means the payer adjusted the claim based on subrogation of a third-party settlement. Another party, such as an at-fault driver's insurer, has settled for the injury, and the payer is reducing or denying its payment because that settlement is expected to cover the care.

Quick facts

Code
CO-215 (CARC 215)
Status
Active In use since January 27, 2008.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The adjustment is applied against the provider's claim. Whether any balance can be pursued elsewhere depends on the settlement, liens, and state law.
  • OA (Other Adjustment): Sometimes used when the payer is reporting the settlement's effect without assigning it to the provider or patient.
  • PR (Patient Responsibility): Sometimes used when the payer considers the patient responsible because the patient received settlement funds for this care.
Official description
Based on subrogation of a third party settlement
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-215 means

CARC 215 means the adjustment is based on subrogation of a third-party settlement. Subrogation is the payer’s right to recover its costs from whoever is legally responsible for an injury. When a patient’s accident claim has already settled with a third party, such as an auto liability insurer or a business’s liability carrier, the health plan may treat that settlement as covering the related medical care. It then reduces or denies its own payment and reports CARC 215.

In practice, this code tells you the money for this care is expected to come from the settlement, not from the health plan. It is informational in the sense that recovery usually happens outside the claim, but it has real consequences for who you bill next.

Common causes

  • Auto accident or premises liability claim settled for the injury being treated.
  • Patient signed a settlement that included medical expenses.
  • Payer’s third-party liability unit matched the diagnosis and accident date to a known settlement.
  • Accident indicators on the claim (box 10a-c) and the accident date (box 14) linked the service to the settled case.
  • Unrelated service swept in because the diagnosis looked accident-related.

How to fix it

  1. Read any remark codes and separate correspondence that describe the settlement.
  2. Confirm with the patient whether a settlement occurred, the date, and whether an attorney is involved.
  3. If the service is unrelated to the accident, correct the accident indicators or diagnosis if they were wrong and submit a corrected claim, or appeal with records showing the care is unrelated.
  4. If the service is related, pursue payment through the settlement: bill the liability insurer if it is still open, or work with the patient’s attorney under a lien where allowed.
  5. Check state law and your payer contract before billing the patient, since some rules limit balance billing in third-party liability cases.
  6. Track the balance separately so it is not written off before settlement options are exhausted.

See eligibility and COB denials for how other-coverage problems ripple through billing.

How to prevent it

  • Ask about accidents and attorney involvement at registration when the visit is injury-related.
  • Capture accident type, date, and liability carrier details up front.
  • Send lien letters to the patient’s attorney early in treatment when appropriate.
  • Keep injury-related accounts on a separate workflow so settlement updates are not missed.

Specialty notes

Chiropractic, physical therapy, orthopedics, and emergency care see this most because they treat accident injuries. Workers’ compensation and property and casualty payers use their own P- and W-related codes for similar situations.

Remark codes that may appear with CO-215

  • N202 (Alert: Additional information/explanation will be sent separately.): The payer will send details about the settlement or subrogation separately.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan terms on third-party liability and subrogation.
  • OA-22 (This care may be covered by another payer per coordination of benefits.): Another payer may be primary under coordination of benefits, which is different from a settlement.
  • OA-23 (The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)): Shows how a prior payer's adjudication affected this claim.
  • CO-P1 (State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation.): A property and casualty state-mandated adjustment, used by P&C payers themselves.

CO-215 FAQ

What is subrogation in medical billing?

Subrogation lets a health plan step into the patient's position to recover what it paid from a responsible third party, such as a liability insurer. When a settlement has already been made, the plan may decline to pay because the settlement covers the costs.

Who do I bill after a CO-215 adjustment?

Ask the payer and the patient how the settlement was handled. Depending on the case, you may be able to bill the liability insurer, the patient's attorney under a lien, or the patient. State law and any lien agreements control this.

Can I appeal CO-215?

Yes, if the injury was not related to the settled claim or no settlement exists. Provide documentation showing the service is unrelated to the accident.