DENIAL CODES

Denial code P23

Denial code P23 is a fee schedule adjustment related to Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits. It is important for providers to refer to specific segments in the 835 document for further information. This code is applicable only for Property and Casualty Auto claims.

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What is Denial Code P23

Denial code P23 is related to Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. This means that the adjustment made by the payer is based on the fee schedule determined by the jurisdiction. If the adjustment is at the Claim Level, the payer is required to send additional information, and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF) for more details.

If the adjustment is at the Line Level, the payer must also send additional information, and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply.

It's important to note that this denial code is specific to Property and Casualty Auto claims only.

Common Causes of CARC P23

Common causes of code P23 are:

1. Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) benefits jurisdictional fee schedule adjustment: This code is used when there is an adjustment related to the fee schedule for MPC or PIP benefits. The adjustment may be at the claim level or line level, and the payer should provide additional information in the 835 Class of Contract Code Identification Segment or the 835 Healthcare Policy Identification Segment.

2. Claim level adjustment: If the adjustment is at the claim level, the payer must send the necessary information, and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF) for further details.3. Line level adjustment: If the adjustment is at the line level, the payer must send the required information, and the provider should refer to the 835 Healthcare Policy Identification Segment (Loop 2110 Service Payment Information REF) if the regulations apply.

4. Property and Casualty Auto only: This code is specific to property and casualty auto claims. It indicates that the adjustment is related to medical payments coverage or personal injury protection benefits in the context of auto insurance.

These are the common causes associated with code P23. Healthcare providers should review the specific details provided by the payer in the 835 transaction to understand the adjustment and take appropriate action.

Ways to Mitigate Denial Code P23

Ways to mitigate code P23 include:

1. Ensure accurate and complete documentation: To prevent this code, healthcare providers should ensure that all documentation related to medical payments coverage (MPC) or personal injury protection (PIP) benefits is accurate and complete. This includes capturing all relevant information such as diagnosis codes, procedure codes, and any other necessary documentation.

2. Verify jurisdictional fee schedules: Providers should regularly verify the jurisdictional fee schedules for MPC or PIP benefits to ensure that they are up to date and in compliance with the payer's requirements. This can help prevent any discrepancies or adjustments that may lead to this code.

3. Review and reconcile 835 transactions: Providers should review and reconcile 835 transactions received from payers to identify any adjustments related to MPC or PIP benefits. By closely monitoring these transactions, providers can quickly identify any issues and take appropriate action to resolve them.

4. Stay informed about healthcare policies: Providers should stay informed about the latest healthcare policies and regulations related to MPC or PIP benefits. This can be done through regular communication with payers, attending industry conferences or webinars, and staying updated on relevant publications or resources.

5. Implement effective claims management processes: Providers should implement effective claims management processes to ensure that claims related to MPC or PIP benefits are submitted accurately and in a timely manner. This includes conducting regular audits of claims data, addressing any coding or documentation errors promptly, and following up on any denials or adjustments received.

By following these strategies, healthcare providers can mitigate code P23 and minimize the risk of denials or adjustments related to MPC or PIP benefits.

How to Address Denial Code P23

The steps to address code P23, Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment, are as follows:

1. If the adjustment is at the Claim Level, the payer must send the necessary information. As a provider, you should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF) to understand the specific details of the adjustment.

2. If the adjustment is at the Line Level, the payer must also send the required information. In this case, as a provider, you should refer to the 835 Healthcare Policy Identification Segment (Loop 2110 Service Payment Information REF) if the regulations apply. This segment will provide you with the relevant information regarding the adjustment.

3. It is important to note that this code, P23, is specifically applicable to Property and Casualty Auto claims. Therefore, ensure that you are dealing with claims related to this category when addressing this code.By following these steps, you will be able to effectively address code P23 and handle the Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment in a compliant manner.

RARCs Associated to CARC P23

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