Denial code 239 means that the claim submitted spans both eligible and ineligible periods of coverage. In order to resolve this denial, it is necessary to rebill separate claims for the eligible and ineligible periods.
Common causes of code 239 are:
1. Incorrect billing period: This code is often triggered when a claim spans both eligible and ineligible periods of coverage. It may occur if the provider bills for services that were provided before the patient's coverage became effective or after the coverage ended. To resolve this, the provider should rebill separate claims for the eligible and ineligible periods.
2. Delayed or inaccurate eligibility updates: If the provider fails to update the patient's eligibility information in a timely manner, it can result in claims being submitted for ineligible periods. This can happen when the patient's coverage is terminated, but the provider continues to bill for services. To avoid this, it is crucial to regularly update and verify the patient's eligibility status.
3. Coordination of benefits issues: Code 239 can also be triggered when there are coordination of benefits (COB) issues. COB occurs when a patient has multiple insurance policies, and the primary insurer has not yet processed the claim. In such cases, the provider should ensure that the primary insurer processes the claim first before submitting it to the secondary insurer.
4. Incorrect coding or documentation: Sometimes, code 239 can be the result of coding or documentation errors. For example, if the provider mistakenly bills for services that were not actually provided during the eligible period, it can lead to a denial. It is important to review the coding and documentation thoroughly to ensure accuracy before submitting the claim.
5. Lack of pre-authorization: Certain healthcare services require pre-authorization from the insurance company before they can be covered. If the provider fails to obtain the necessary pre-authorization, it can result in claims being denied under code 239. To avoid this, it is essential to verify the pre-authorization requirements for specific services and obtain approval before rendering them.
6. Incomplete or missing information: Insufficient or missing information on the claim form can also trigger code 239. This can include incomplete patient demographics, incorrect insurance information, or missing supporting documentation. Providers should ensure that all required fields are completed accurately and all necessary documentation is included to avoid claim denials.
7. System or technical errors: Occasionally, code 239 denials can occur due to system or technical errors. This can include issues with the billing software, electronic data interchange (EDI) transmission errors, or glitches in the claims processing system. In such cases, it is important to identify and rectify the technical issue to resubmit the claim successfully.
It is important for healthcare providers to address these common causes of code 239 to minimize claim denials and optimize revenue cycle management. By implementing proper billing practices, staying updated with eligibility information, and ensuring accurate coding and documentation, providers can improve their reimbursement rates and streamline their revenue cycle.
Ways to mitigate code 239 include rebilling separate claims when a claim spans both eligible and ineligible periods of coverage. By separating the claim into multiple submissions, healthcare providers can ensure that each claim accurately reflects the specific period of coverage for which the services were rendered. This helps to avoid any confusion or discrepancies that may arise when a claim covers both eligible and ineligible periods. By rebilling separate claims, providers can improve the accuracy and efficiency of their revenue cycle management process, reducing the likelihood of denials associated with code 239.
The steps to address code 239 are as follows:
- Review the claim details: Carefully examine the claim to determine which periods of coverage are eligible and which are ineligible. This will help you understand why the claim spans both types of coverage.
- Identify the eligible and ineligible periods: Clearly identify the specific dates or timeframes that fall under the eligible and ineligible periods of coverage. This will help you determine the appropriate actions to take.
- Separate the claim: Once you have identified the eligible and ineligible periods, separate the claim into multiple claims. Create separate claims for each period of coverage to ensure accurate billing and reimbursement.
- Rebill the separate claims: Submit the separate claims to the appropriate payer, ensuring that each claim accurately reflects the specific period of coverage it represents. This will help streamline the reimbursement process and reduce the chances of claim denials.
- Provide supporting documentation: Include any necessary supporting documentation, such as medical records or documentation of eligibility, with each separate claim. This will help validate the accuracy and legitimacy of the claims, increasing the chances of successful reimbursement.
- Monitor the reimbursement process: Keep track of the progress of each separate claim and follow up with the payer if necessary. This will help ensure timely and accurate reimbursement for each period of coverage.
By following these steps, you can effectively address code 239 and take the necessary actions to rebill separate claims, ultimately improving the revenue cycle management process for your healthcare organization.