Denial code 227 means that the requested information from the patient, insured, or responsible party was either not provided or was insufficient or incomplete. In order to process the claim, at least one Remark Code must be provided. This Remark Code can be either the NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT.
Common causes of code 227 are:
1. Incomplete patient information: The healthcare provider may have failed to collect all the necessary information from the patient, insured party, or responsible party. This could include missing contact details, insurance information, or other essential data required for claims processing.
2. Insufficient documentation: The documentation provided by the patient, insured party, or responsible party may be incomplete or insufficient to support the claim. This could include missing medical records, diagnostic reports, or other supporting documents required for proper billing and reimbursement.
3. Lack of response from the patient/insured/responsible party: The healthcare provider may have requested additional information or documentation from the patient, insured party, or responsible party, but did not receive a timely response. Without the necessary information, the claim cannot be processed correctly, resulting in a denial with code 227.
4. Missing or incorrect remark code: When submitting a claim, it is essential to include the appropriate remark code to provide additional context or explanation for the denial. If the remark code is missing or incorrect, it can lead to a denial with code 227.
5. Non-compliance with NCPDP reject reason code: The National Council for Prescription Drug Programs (NCPDP) provides reject reason codes that indicate specific issues with claims. If the healthcare provider fails to comply with the required NCPDP reject reason code, it can result in a denial with code 227.
6. Non-compliance with remittance advice remark code: Similarly, if the healthcare provider fails to include the appropriate remittance advice remark code that is not an ALERT, it can lead to a denial with code 227. These remark codes provide additional information about the denial or payment adjustment.
It is important for healthcare providers to address these common causes to minimize claim denials and ensure a smooth revenue cycle management process.
Ways to mitigate code 227 include:
- Improve patient communication: Enhance the communication process with patients to ensure that all necessary information is collected accurately and completely. This can be achieved by training staff members on effective communication techniques and providing them with the necessary tools to gather all required information.
- Streamline data collection processes: Implement streamlined processes for collecting patient information, such as using electronic forms or online portals. This can help ensure that all necessary information is captured in a standardized and complete manner, reducing the chances of insufficient or incomplete data.
- Conduct regular staff training: Provide comprehensive training to staff members involved in the revenue cycle management process. This training should focus on the importance of collecting complete and accurate patient information and provide them with the necessary knowledge and skills to do so effectively.
- Implement quality assurance measures: Establish quality assurance measures to review and validate patient information before it is submitted for billing. This can include conducting regular audits of patient records to identify any missing or incomplete information and taking corrective actions promptly.
- Utilize technology solutions: Leverage technology solutions, such as electronic health record systems or revenue cycle management software, to automate data collection processes and minimize the risk of missing or incomplete information. These systems can provide prompts and reminders to ensure that all necessary information is captured before submission.
- Enhance documentation practices: Encourage healthcare providers to maintain thorough and detailed documentation of patient encounters. This documentation should include all relevant information required for billing purposes, reducing the likelihood of insufficient or incomplete data.
By implementing these strategies, healthcare providers can mitigate code 227 and improve their revenue cycle management processes, leading to fewer denials and improved financial outcomes.
The steps to address code 227 are as follows:
- Review the claim: Carefully review the claim to ensure that all necessary information was included. Check if any required fields were left blank or if any data was incomplete or inaccurate.
- Contact the patient/insured/responsible party: Reach out to the patient, insured, or responsible party to obtain the missing or insufficient information. Clearly communicate what specific information is needed and provide them with a deadline for submission.
- Document the communication: Keep a record of all interactions with the patient/insured/responsible party regarding the missing information. This documentation will be useful for future reference and can serve as evidence of attempts made to obtain the required details.
- Update the claim: Once the missing or insufficient information has been obtained, update the claim with the correct data. Ensure that all necessary fields are completed accurately and completely.
- Include Remark Code: Add the appropriate Remark Code to the claim. This code should explain the reason for the missing information and indicate that it has been resolved. Use the NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT.
- Resubmit the claim: After making the necessary updates and including the Remark Code, resubmit the claim to the payer for reconsideration. Double-check that all other aspects of the claim are accurate and complete before resubmission.
- Monitor the claim: Keep track of the claim's progress after resubmission. Follow up with the payer if necessary to ensure that the claim is being processed correctly and that the missing information issue has been resolved.
By following these steps, healthcare providers can effectively address code 227 and increase the chances of successful claim reimbursement.