Denial code 140 is used when the patient or insured person's health identification number and name do not match. This means that the information provided for the patient's health insurance does not match the records held by the insurance company. It could be due to a typographical error, a mismatch in the information provided, or a discrepancy in the records. This denial code indicates that the claim has been rejected because the insurance company cannot verify the identity of the patient or insured person based on the information provided.
Common causes of code 140 are:
1. Data entry errors: One of the most common causes of this denial code is a simple data entry mistake. It could be a typo or a transposition error when entering the patient or insured health identification number or name. Such errors can lead to a mismatch between the two, triggering the denial.
2. Outdated or incorrect patient information: If the patient or insured health identification number or name provided on the claim is outdated or incorrect, it will not match the information on file with the insurance company. This can result in a denial of the claim.
3. Name change or update not communicated: If the patient has recently changed their name or updated their health identification number, but this information has not been properly communicated to the insurance company, it can cause a mismatch between the provided information and the records on file.
4. Insurance coverage discrepancy: In some cases, the patient's insurance coverage may have changed or expired, but this information has not been updated in the healthcare provider's system. As a result, the health identification number or name provided on the claim may not match the current insurance coverage, leading to a denial.
5. Duplicate or multiple health identification numbers: If the patient has multiple health identification numbers, it is important to ensure that the correct one is used on the claim. Using an incorrect or duplicate health identification number can cause a mismatch and result in a denial.
6. Name variations or aliases: Patients may have variations in their names or use aliases, especially if they have recently married or divorced. If the name provided on the claim does not match the name on file with the insurance company, it can lead to a denial.
7. System integration issues: Sometimes, denials can occur due to technical issues or system integration problems between the healthcare provider's billing system and the insurance company's system. These issues can cause discrepancies in the patient or insured health identification number and name, resulting in a denial.
It is important for healthcare providers to review and verify patient information carefully before submitting claims to minimize the occurrence of code 140 denials.
Ways to mitigate code 140 include:
- Verify patient information: Ensure that the patient's health identification number and name are accurately recorded in the system. Double-check the information provided by the patient during registration or update the records if any discrepancies are found.
- Improve data entry processes: Implement robust data entry protocols to minimize errors. Train staff members responsible for entering patient information to pay close attention to detail and cross-check the accuracy of the health identification number and name before saving the data.
- Enhance patient verification procedures: Implement a stringent patient verification process to confirm the accuracy of the health identification number and name. This can include requesting additional identification documents or contacting the insurance provider directly to validate the patient's information.
- Regularly update patient records: Encourage patients to provide updated information whenever there are changes to their health identification number or name. Regularly review and update patient records to ensure they align with the most current information available.
- Utilize technology solutions: Implement automated systems or software that can help identify potential discrepancies between the health identification number and name. These tools can flag any inconsistencies, allowing staff members to address them promptly.
- Conduct internal audits: Regularly conduct internal audits of patient records to identify any recurring issues related to code 140. By proactively identifying and addressing these issues, you can prevent future occurrences and improve overall data accuracy.
- Provide staff training: Educate your staff on the importance of accurate patient information and the potential consequences of mismatched health identification numbers and names. Offer training sessions to enhance their understanding of the revenue cycle management process and the significance of mitigating code 140.
By implementing these strategies, healthcare providers can minimize the occurrence of code 140 and ensure that patient and insurance information aligns accurately, reducing the risk of claim denials and improving revenue cycle management efficiency.
The steps to address code 140, which indicates that the patient/insured health identification number and name do not match, are as follows:
- Verify the patient's health identification number: Double-check the health identification number provided by the patient or their insurance company. Ensure that the number is entered correctly and matches the patient's records.
- Confirm the patient's name: Compare the patient's name on the claim with the name on their insurance card or any other official documents. Look for any discrepancies or misspellings that may have caused the code 140 error.
- Contact the patient or insurance company: If there is a discrepancy between the health identification number and the patient's name, reach out to the patient or their insurance company for clarification. Obtain the correct information and update the claim accordingly.
- Update the claim: Once you have obtained the correct health identification number and name, update the claim with the accurate information. Make sure to make the necessary changes in your billing system or software.
- Resubmit the claim: After updating the claim, resubmit it to the insurance company for processing. Ensure that all the corrected information is included and accurately reflected in the resubmitted claim.
- Document the changes: Keep a record of the steps taken to address code 140. Maintain a log or note in the patient's file, indicating the date, time, and details of the correction made. This documentation will be helpful for future reference and audit purposes.
By following these steps, healthcare providers can effectively address code 140 and ensure that the patient/insured health identification number and name match, reducing the likelihood of claim denials and delays in reimbursement.