Denial code 107 means that the claim has been denied because the related or qualifying claim or service was not identified on this particular claim. To resolve this issue, you should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) if it is present. This segment will provide more information or guidance on how to correctly identify and link the related or qualifying claim/service to ensure proper processing and payment.
Common causes of code 107 are:
- Failure to properly identify the related or qualifying claim/service on the submitted claim.
- Missing or incorrect information in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF).
- Inadequate documentation or lack of supporting documentation for the related or qualifying claim/service.
- Coding errors or discrepancies in the claim, such as incorrect procedure or diagnosis codes.
- Failure to follow specific payer guidelines or requirements for identifying related or qualifying claims/services.
- Technical issues or errors in the electronic submission of the claim, leading to the omission or misinterpretation of the related or qualifying claim/service.
- Lack of coordination or communication between different departments or entities involved in the claims submission process, resulting in the omission or misidentification of the related or qualifying claim/service.
- Insufficient training or knowledge of the billing and coding staff regarding the proper identification and documentation of related or qualifying claims/services.
- Changes in payer policies or guidelines that were not properly communicated or implemented, leading to the incorrect identification or omission of the related or qualifying claim/service.
- Inaccurate or incomplete patient information, such as missing or incorrect insurance details, which can hinder the proper identification of the related or qualifying claim/service.
Ways to mitigate code 107 include:
- Double-checking claim information: Ensure that all relevant information, such as the related or qualifying claim/service, is accurately entered on the claim form. This includes verifying that the correct codes and modifiers are used to identify the services provided.
- Utilizing electronic claim submission: Submitting claims electronically can help reduce the chances of errors or omissions. Electronic claim submission systems often have built-in validation checks that can flag missing or incorrect information before the claim is submitted.
- Implementing claim scrubbing software: Consider using claim scrubbing software that can automatically review claims for errors or missing information. This software can help identify any issues before the claim is submitted, allowing for corrections to be made in a timely manner.
- Conducting regular staff training: Provide ongoing training to your billing and coding staff to ensure they are up-to-date with the latest coding guidelines and requirements. This can help reduce the likelihood of errors or omissions that may lead to denials, including code 107.
- Performing internal audits: Regularly audit your claims to identify any patterns or trends that may be leading to denials, including code 107. By proactively identifying and addressing these issues, you can prevent future denials and improve your revenue cycle management.
- Establishing clear communication channels: Foster open communication between your billing and coding staff, providers, and payers. This can help ensure that all parties are aware of any specific requirements or documentation needed to support the claim and prevent denials.
Remember, these strategies are general recommendations and may need to be tailored to your specific practice or organization. By proactively addressing potential issues that may lead to code 107 denials, you can improve your revenue cycle management and minimize the impact on your bottom line.
The steps to address code 107 are as follows:
- Review the claim thoroughly to ensure that all related or qualifying claim/services are accurately identified and included.
- Double-check the documentation and coding to verify that the related claim/service was properly documented and coded.
- If the related claim/service was indeed included in the claim, check if the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) is present.
- If the 835 Healthcare Policy Identification Segment is present, review it carefully to ensure that the necessary information is accurately provided.
- If the 835 Healthcare Policy Identification Segment is not present, reach out to the appropriate department or individual responsible for generating the segment and request them to include it.
- Communicate with the payer or insurance company to clarify any confusion or provide additional information if needed.
- Keep a record of all communication and documentation related to addressing code 107 for future reference and audit purposes.
- Monitor the status of the claim closely to ensure that it is processed correctly and any issues related to code 107 are resolved in a timely manner.
By following these steps, healthcare providers can effectively address code 107 and work towards resolving any related issues with the claim.