Denial code 270 is used when a claim is received by the medical plan, but the benefits for the services provided are not available under that specific plan. In this case, it is recommended to submit these services to the patient's dental plan for further consideration.
Common causes of code 270 are:
1. The claim was submitted to a medical plan instead of a dental plan. This code indicates that the services provided are not covered under the patient's medical plan, but may be covered under their dental plan. To resolve this, the claim should be resubmitted to the appropriate dental plan for further consideration.
2. The patient does not have dental coverage. This denial code may occur if the patient does not have dental insurance or if their dental coverage has expired. In such cases, the patient may be responsible for paying for the services out of pocket.
3. The services provided are not covered by the dental plan. This code may be triggered if the specific services or procedures performed are not included in the patient's dental plan coverage. In this case, the patient may need to explore alternative payment options or discuss the situation with their dental plan provider.
4. Incorrect or incomplete patient information. Denial code 270 can also be caused by errors or omissions in the patient's information, such as incorrect insurance details or missing policy numbers. Verifying and updating the patient's information can help resolve this issue.
5. Coordination of benefits (COB) issues. If the patient has multiple insurance plans, this code may indicate that the claim needs to be submitted to another insurance provider for coordination of benefits. It is important to ensure that all relevant insurance information is provided and that the claim is submitted to the correct insurance company.
6. Pre-authorization or referral requirements not met. Some dental plans may require pre-authorization or referrals for certain procedures or services. If these requirements are not met, the claim may be denied with code 270. It is essential to verify and fulfill any pre-authorization or referral requirements before submitting the claim.
7. Out-of-network provider. If the dental provider is not in the patient's dental plan network, the claim may be denied with code 270. Patients should be informed about their network coverage and potential out-of-pocket expenses when seeking services from an out-of-network provider.
It is important for healthcare providers to understand these common causes of denial code 270 to effectively address and resolve claim denials, ensuring timely reimbursement and minimizing revenue cycle disruptions.
Ways to mitigate code 270 include:
1. Verify eligibility: Before submitting a claim to the medical plan, it is crucial to verify the patient's eligibility and benefits. This can be done by contacting the insurance company directly or using an online eligibility verification tool. By ensuring that the services are covered under the patient's medical plan, you can avoid receiving this denial code.
2. Coordinate with dental plan: If the services provided are dental-related, it is important to submit the claim to the patient's dental plan instead of the medical plan. By coordinating with the dental plan and following their specific guidelines, you can increase the chances of receiving reimbursement for the services rendered.
3. Accurate coding: Ensure that the services are coded accurately using the appropriate medical codes. This includes selecting the correct diagnosis and procedure codes that align with the patient's medical condition and the services provided. By coding accurately, you can minimize the risk of receiving denial code 270.
4. Clear documentation: Maintain clear and detailed documentation of the services rendered, including the medical necessity for the procedures performed. This documentation should support the need for the services under the patient's medical plan. Clear and comprehensive documentation can help prevent denials and support successful appeals if necessary.
5. Stay updated with plan changes: Insurance plans often update their coverage policies and guidelines. It is important to stay informed about any changes that may impact the reimbursement of certain services. Regularly review the plan's updates and communicate with the insurance company to ensure compliance with their requirements.
6. Appeal if necessary: In case you receive denial code 270 despite taking preventive measures, consider appealing the decision. Review the denial reason provided by the insurance company and gather any additional documentation or information that supports the medical necessity of the services. Submit a well-structured appeal with all the necessary details to increase the chances of overturning the denial.
By implementing these strategies, healthcare providers can mitigate denial code 270 and improve their revenue cycle management.
The steps to address code 270 are as follows:
1. Review the patient's insurance information: Verify that the patient's dental plan information is accurate and up to date. Ensure that the claim was submitted to the correct plan.
2. Confirm the services provided: Double-check the services that were included in the claim. Make sure that they are eligible for coverage under the patient's dental plan. If any services are not covered, consider alternative billing options or discuss with the patient if they are willing to pay out-of-pocket.
3. Contact the dental plan: Reach out to the patient's dental plan to inquire about the reason for the denial. Provide any necessary documentation or additional information that may support the claim. Ask for clarification on why the benefits are not available under the plan.
4. Appeal the denial if necessary: If you believe that the services should be covered under the patient's dental plan, consider filing an appeal. Follow the dental plan's appeal process and provide any supporting documentation or evidence to support your case.
5. Communicate with the patient: Keep the patient informed about the denial and the steps being taken to address it. Explain any potential financial responsibility they may have and discuss possible options for resolving the issue.
6. Follow up and track progress: Monitor the progress of the appeal or any further communication with the dental plan. Keep detailed records of all interactions and documentation submitted. Follow up regularly to ensure that the issue is being addressed and resolved in a timely manner.
Remember, each denial code may require different steps to address it effectively. It is crucial to thoroughly understand the specific denial code and the corresponding actions needed to resolve it.