Appealing a UnitedHealthcare / Optum CO-22 Denial
A UnitedHealthcare / Optum CO-22 denial (coordination of benefits) is one of the most common claim rejections behavioral health therapists face. This guide explains exactly what caused the denial and the most effective appeal strategy for behavioral health practices.
What this denial means
The payer believes another insurer should pay first. This triggers when a patient has multiple insurance plans and the primary/secondary sequence was not established or was submitted out of order.
Your appeal strategy
Verify the patient's COB information and confirm which plan is primary. Submit the EOB from the primary payer with the secondary claim. If your payer is primary but coded the claim as secondary, provide the COB letter or member insurance card showing your payer's priority status.
What UnitedHealthcare / Optum requires
P.O. Box 30432
Salt Lake City, UT 84130
30 calendar days (Level-1 appeal)
60 days from Level-1 denial
1-801-938-2100
UHC/Optum manages behavioral health in-house for most commercial products. Document the prior-authorization and medical-necessity criteria carefully and request the CAA 2021 § 203 NQTL comparative analysis in writing. (Note: the Wit v. United Behavioral Health litigation was substantially reversed by the Ninth Circuit in 2022–2023 and should not be cited as binding authority in an appeal.)
Generate your UnitedHealthcare / Optum CO-22 appeal letter
Therapists get 5 free letters every month. Appealing your own denial? It's $19 per letter, one-time, no subscription. No credit card needed to start.
Generate my appeal letter →Frequently asked questions
How long does UnitedHealthcare / Optum have to respond to a CO-22 appeal?
Under federal regulations and most state prompt-payment laws, UnitedHealthcare / Optum must respond to a Level-1 internal appeal within 30 calendar days. If you receive an adverse determination, you typically have 60 calendar days from the date of the Level-1 denial to request external review. Send the appeal via certified mail or through the payer's portal and keep documentation of the submission date.
Does MHPAEA apply to CO-22 denials?
CO-22 denials are not directly tied to mental health parity protections in most cases — this code is a general adjudication rule that applies equally to all claim types. MHPAEA may still be relevant if the underlying reason for the denial differs for mental health vs. medical/surgical services.
Can I appeal a CO-22 denial more than once?
Yes. Most payers, including UnitedHealthcare / Optum, allow at least two levels of internal appeal (Level-1 and Level-2 or "expedited" review). Keep copies of every appeal, submission confirmation, and payer response. After exhausting internal appeals, fully-insured commercial and ACA marketplace plans give you the right to request an Independent Medical Review (IMR) or external review through your state Department of Insurance. Self-funded employer (ERISA) plans instead use the federal external-review process overseen by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) — not the state insurance commissioner. Check your plan documents or Summary Plan Description to confirm which applies.
What documentation do I need to appeal a CO-22 denial from UnitedHealthcare / Optum?
At minimum: the original Explanation of Benefits (EOB) or Remittance Advice (RA) showing the CO-22 denial, the original claim details (CPT code, date of service, NPI, charge amount), and any clinical documentation supporting medical necessity. Submit everything in one packet with a cover letter citing the specific denial code, the date of service, and the claim number.