Denial code 277

Denial code 277 is when a claim or service is not determined during the premium payment grace period. It will be reversed and corrected once the grace period ends. #healthcarerevenuecyclemanagement #denialcodes

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What is Denial Code 277

Denial code 277 is used when the disposition of a claim or service is undetermined during the premium payment grace period, as required by the Health Insurance SHOP Exchange. This means that the claim or service will be reversed and corrected once the grace period ends, either due to the payment of the premium or the lack of premium payment. This denial code is only used with Group Code OA.

Common Causes of CARC 277

Common causes of code 277 are:

- The claim or service was submitted during the premium payment grace period, which is the period of time allowed for the payment of insurance premiums without coverage being terminated.

- The health insurance plan is purchased through the Health Insurance SHOP Exchange, which is a marketplace where small businesses can compare and purchase health insurance plans for their employees.

- The disposition of the claim or service is undetermined because it was submitted during the grace period, and the insurance company is waiting for the premium payment to be made or to determine if there was a lack of premium payment.

- This code is typically used with Group Code OA, which indicates that the claim or service will be reversed and corrected once the grace period ends and the premium payment is made or the lack of premium payment is confirmed.

Ways to Mitigate Denial Code 277

Ways to mitigate code 277 include:

1. Timely premium payment: Ensure that premium payments are made on time to avoid any grace period issues. Implement a robust payment tracking system to ensure that payments are received and processed promptly.

2. Clear communication with patients: Educate patients about the importance of timely premium payments and the potential consequences of non-payment. Provide clear instructions on how to make payments and offer assistance if needed.

3. Streamlined claims submission: Implement efficient processes for claims submission to minimize any delays or errors. Train staff members on proper coding and documentation practices to ensure accurate and complete claim submissions.

4. Regular eligibility verification: Conduct regular eligibility checks to ensure that patients' insurance coverage is active and up to date. This will help identify any potential issues with premium payments and allow for timely resolution.

5. Proactive follow-up on unpaid premiums: Monitor premium payment status closely and proactively follow up with patients who have unpaid premiums. Implement a system to track and manage outstanding payments, sending reminders and offering assistance to resolve any payment issues.

6. Collaboration with insurance providers: Maintain open lines of communication with insurance providers to address any premium payment-related concerns promptly. Establish a strong working relationship with insurance representatives to facilitate quick resolution of any issues that may arise.

7. Documentation and record-keeping: Maintain accurate and detailed records of premium payments, eligibility verifications, and any communication with patients and insurance providers. This documentation will serve as evidence of compliance and can be used for reference in case of any disputes or audits.

By implementing these strategies, healthcare providers can mitigate code 277 and minimize the risk of claim denials related to premium payment grace period issues.

How to Address Denial Code 277

The steps to address code 277 (Group Code OA) are as follows:

1. Review the claim details: Carefully examine the claim/service in question to understand the specific circumstances that led to the code 277 denial. This may involve reviewing the patient's insurance coverage, premium payment history, and any relevant documentation.

2. Verify premium payment grace period: Determine whether the claim/service falls within the premium payment grace period as defined by the Health Insurance SHOP Exchange requirements. This information can usually be obtained from the insurance provider or through the online portal.

3. Identify payment status: Determine whether the premium payment has been made or if there is a lack of premium payment. This will help in understanding the reason for the code 277 denial.

4. Communicate with the insurance provider: Contact the insurance provider to discuss the denial and seek clarification on the specific requirements for reversing and correcting the claim/service. Provide all necessary information and documentation to support your case.

5. Take appropriate action: Based on the information received from the insurance provider, take the necessary steps to address the code 277 denial. This may involve reversing and correcting the claim/service once the grace period ends, either due to premium payment or lack of premium payment.

6. Document all actions taken: Maintain a detailed record of all communication with the insurance provider, including dates, names of individuals spoken to, and any reference numbers provided. This documentation will be valuable in case of any further disputes or appeals.

7. Follow up and monitor: Keep track of the claim/service status and ensure that the necessary actions are taken within the specified timeframe. If the denial persists or additional information is required, follow up with the insurance provider to resolve the issue promptly.

By following these steps, healthcare providers can effectively address code 277 and work towards resolving the denial in a timely manner.

RARCs Associated to CARC 277

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