Denial code 139 is used when the subscriber, who is the individual receiving healthcare services, is employed by the provider of those services. This denial code should be used in conjunction with Group Code CO, which typically indicates that the denial is related to contractual obligations or agreements.
Common causes of code 139 are:
1. Subscriber is employed by the provider of services: This denial code may occur when the subscriber, who is the patient's primary insurance policyholder, is employed by the healthcare provider. In such cases, the insurance company may consider this as a conflict of interest and deny the claim.
2. Contracted funding agreement: Code 139 may be triggered when there is a contracted funding agreement between the healthcare provider and the insurance company. This agreement may have specific terms and conditions that need to be met for the claim to be accepted. If these conditions are not met, the claim may be denied.
3. Use only with Group Code CO: This denial code is specific to claims that are submitted with Group Code CO. Group Code CO refers to contractual obligations between the provider and the payer. If the claim does not meet the criteria for this group code, it may result in a denial with code 139.
It is important for healthcare providers to review their contracts and agreements with insurance companies to ensure compliance and avoid denials with code 139. Additionally, verifying the employment status of the subscriber and understanding the specific requirements for Group Code CO can help prevent this denial code from occurring.
Ways to mitigate code 139 include:
- Verify employment status: Ensure that the subscriber is indeed employed by the provider of services. This can be done by cross-checking the employment records and validating the information provided by the subscriber.
- Review contracted funding agreement: Thoroughly examine the contracted funding agreement between the provider and the subscriber's employer. Ensure that the agreement clearly states the terms and conditions regarding the subscriber's employment and coverage.
- Maintain accurate documentation: Keep detailed and accurate records of the subscriber's employment status and any changes that occur over time. This documentation will serve as evidence in case of any disputes or denials related to code 139.
- Educate staff on coding guidelines: Train your staff, particularly those involved in coding and billing, on the specific coding guidelines related to code 139. This will help them accurately identify situations where this code may be applicable and take necessary steps to prevent denials.
- Regularly update systems and software: Stay up-to-date with the latest coding and billing software updates. This will ensure that your systems are equipped to handle code 139 and other relevant codes, minimizing the chances of denials.
- Conduct internal audits: Regularly perform internal audits to identify any potential issues or discrepancies related to code 139. This proactive approach will help you identify and rectify any problems before they result in denials.
- Establish clear communication channels: Maintain open lines of communication with the subscriber's employer and other relevant stakeholders. This will help you address any concerns or questions related to code 139 and ensure a smooth claims process.
By implementing these strategies, healthcare providers can effectively mitigate code 139 and reduce the risk of denials, leading to improved revenue cycle management.
The steps to address code 139 (Contracted funding agreement - Subscriber is employed by the provider of services. Use only with Group Code CO) are as follows:
1. Review the claim details: Carefully examine the claim to ensure that all the necessary information, such as patient demographics, service dates, and procedure codes, are accurate and complete.
2. Verify the contracted funding agreement: Confirm that the subscriber is indeed employed by the provider of services mentioned in the claim. This can be done by cross-referencing the subscriber's employment records or contacting the provider directly.
3. Check for Group Code CO: Ensure that the claim includes the appropriate Group Code CO, which indicates that a contracted funding agreement is in place. If the code is missing or incorrect, it may need to be added or corrected.
4. Investigate any discrepancies: If there are any discrepancies or inconsistencies in the claim, such as conflicting information or missing documentation, investigate and resolve them promptly. This may involve reaching out to the relevant parties, such as the subscriber or the provider, to gather additional information or clarification.
5. Make necessary adjustments: If any errors or omissions are identified, make the necessary adjustments to the claim. This may involve correcting coding errors, updating patient information, or attaching any missing documentation.
6. Resubmit the claim: Once all the necessary adjustments have been made, resubmit the claim for processing. Ensure that it is submitted within the designated timeframe specified by the payer to avoid any potential delays or denials.
7. Monitor the claim status: Keep track of the claim's progress and regularly check its status. If the claim is still being denied or encountering issues related to code 139, further investigation or escalation may be required.
By following these steps, healthcare providers can effectively address code 139 and work towards resolving any issues or denials associated with it.