Denial code 20 means that the injury or illness being claimed is covered by the liability carrier. In other words, the healthcare provider's claim for reimbursement has been denied because the responsibility for payment lies with another party, such as an insurance company or a liability carrier.
Common causes of code 20 are:
- The injury or illness being treated is related to a liability claim, such as a workplace injury or a motor vehicle accident. In these cases, the liability carrier is responsible for covering the medical expenses.
- The healthcare provider may have submitted the claim to the wrong insurance carrier. It is important to ensure that the claim is sent to the correct liability carrier to avoid denials.
- The documentation provided by the healthcare provider may not clearly indicate that the injury or illness is related to a liability claim. Clear and detailed documentation is crucial to support the claim and prevent denials.
- The liability carrier may have specific requirements or guidelines for processing claims related to injuries or illnesses. Failure to meet these requirements can result in denials.
- The claim may be missing necessary supporting documentation, such as accident reports or witness statements, which are required by the liability carrier to process the claim.
- The healthcare provider may not have obtained the necessary authorization or approval from the liability carrier before providing treatment. Without proper authorization, the claim is likely to be denied.
- The liability carrier may have specific coverage limitations or exclusions that apply to the injury or illness being treated. It is important to review the policy terms and conditions to ensure that the claim falls within the coverage guidelines.
- Errors or inaccuracies in the claim submission, such as incorrect patient information or coding mistakes, can lead to denials related to liability claims.
- The liability carrier may have reached its coverage limit for the specific injury or illness, resulting in denials for further treatment.
- Changes in the liability carrier's policies or procedures may result in denials for claims that were previously covered. It is important to stay updated on any changes to ensure proper claim submission.
Ways to mitigate code 20 include:
- Verify insurance coverage: Before providing any services, it is crucial to verify the patient's insurance coverage. Ensure that the patient's liability carrier information is accurate and up to date. This can help prevent denials related to coverage issues.
- Obtain pre-authorization: For certain procedures or treatments, it may be necessary to obtain pre-authorization from the liability carrier. This step ensures that the services provided are deemed medically necessary and covered by the insurance. Failure to obtain pre-authorization can result in denials with code 20.
- Accurate documentation: Proper documentation is essential to support the medical necessity of the services provided. Ensure that all relevant information, including the details of the injury or illness, is accurately documented in the patient's medical record. This documentation should clearly demonstrate the need for the services and their connection to the liability carrier's coverage.
- Clear communication: Effective communication with the liability carrier is crucial to prevent code 20 denials. When submitting claims, ensure that all necessary information is included and accurately conveyed. Promptly respond to any requests for additional information or clarification from the liability carrier to avoid potential denials.
- Stay updated with liability carrier policies: Stay informed about the specific policies and guidelines of the liability carrier. Regularly review any updates or changes in their coverage criteria to ensure compliance. This proactive approach can help prevent denials related to coverage issues.
- Utilize technology and automation: Implementing revenue cycle management software or tools can streamline the claims submission process and reduce the chances of errors. These technologies can help identify any potential issues or discrepancies before submitting claims, minimizing the risk of denials with code 20.
By following these strategies, healthcare providers can mitigate code 20 denials and improve their revenue cycle management process.
The steps to address code 20 are as follows:
- Review the patient's insurance information: Verify that the patient has provided accurate and up-to-date insurance information. Ensure that the liability carrier information is correctly entered in the billing system.
- Gather necessary documentation: Collect all relevant documentation related to the injury or illness. This may include accident reports, police reports, witness statements, and any other supporting evidence.
- Contact the liability carrier: Reach out to the liability carrier to initiate the claims process. Provide them with the necessary documentation and any additional information they may require. Keep a record of all communication with the liability carrier for future reference.
- Follow up regularly: Stay in touch with the liability carrier to ensure that the claim is being processed in a timely manner. Keep track of any claim numbers or reference numbers provided by the carrier.
- Coordinate with other parties involved: If there are multiple parties involved in the liability claim, such as attorneys or other healthcare providers, collaborate with them to ensure a smooth claims process. Share relevant information and updates as needed.
- Monitor the claim status: Regularly check the status of the claim to ensure that it is progressing appropriately. If there are any delays or issues, follow up with the liability carrier to address them promptly.
- Document everything: Maintain detailed records of all interactions, documentation, and steps taken throughout the claims process. This will help in case of any disputes or further inquiries.
- Appeal if necessary: If the liability carrier denies the claim or provides inadequate reimbursement, consider appealing the decision. Gather any additional supporting documentation or evidence that may strengthen your case.
Remember, each liability claim may have its own unique requirements and processes. It is essential to stay proactive, organized, and persistent when addressing code 20 to ensure proper reimbursement for the services provided.