Denial code P8 is for claims under investigation. Providers should refer to the 835 Insurance Policy Number Segment or the 835 Healthcare Policy Identification Segment for more information. Property and Casualty only.
Denial code P8 is used when a claim is under investigation. If the adjustment is at the claim level, the payer is required to send the provider an 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') that contains information about the jurisdictional regulation. On the other hand, if the adjustment is at the line level, the payer must send the provider an 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). It's important to note that this denial code is specifically used for Property and Casualty claims.
Common causes of code P8 are:
1. Claim is under investigation: This code is typically used when the payer is conducting an investigation into the claim. It may indicate that there are concerns or discrepancies that need to be resolved before the claim can be processed further.
2. Adjustment at the Claim Level: If the adjustment is at the claim level, the payer is required to send additional information related to the insurance policy number. The provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for jurisdictional regulations.
3. Adjustment at the Line Level: If the adjustment is at the line level, the payer is required to send additional information related to healthcare policy identification. The provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). This code is typically used for Property and Casualty claims only.
It is important for healthcare providers to understand these common causes of code P8 in order to effectively address any issues or discrepancies with the claim and ensure timely reimbursement.
Ways to mitigate code P8 include:
1. Ensure accurate and complete documentation: One of the main reasons for claims being flagged for investigation is incomplete or inaccurate documentation. To prevent this, healthcare providers should ensure that all necessary information, such as patient demographics, medical history, and treatment details, is documented accurately and completely.
2. Verify insurance coverage: Before submitting a claim, it is crucial to verify the patient's insurance coverage and eligibility. This can help identify any potential issues or discrepancies that may lead to a claim being flagged for investigation. Providers should regularly update and verify insurance information to minimize the risk of denials.
3. Submit clean claims: Clean claims are those that are error-free and comply with all payer requirements. To prevent code P8, providers should ensure that claims are submitted with accurate coding, proper modifiers, and appropriate documentation. Regular training and education for coding and billing staff can help improve accuracy and reduce the likelihood of claims being flagged for investigation.
4. Stay updated with payer policies: Payer policies and regulations can change frequently, and it is essential for healthcare providers to stay updated with these changes. By regularly reviewing and understanding payer policies, providers can ensure that claims are submitted in compliance with the latest guidelines, reducing the risk of denials and investigations.
5. Implement effective revenue cycle management processes: A well-structured revenue cycle management (RCM) process can help identify and address potential issues before claims are submitted. This includes conducting regular audits, implementing quality assurance measures, and utilizing technology solutions that can flag potential errors or discrepancies. By proactively managing the revenue cycle, providers can minimize the risk of claims being flagged for investigation.
6. Establish open communication with payers: Building strong relationships and open lines of communication with payers can help resolve any potential issues or discrepancies before they escalate to an investigation. Providers should establish regular communication channels with payers to address any concerns, clarify coding or billing questions, and ensure a smooth claims submission process.
By implementing these strategies, healthcare providers can mitigate code P8 and reduce the likelihood of claims being flagged for investigation.
The steps to address code P8 are as follows:1. If the adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation.2. If the adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF).3. It is important to note that this code is to be used for Property and Casualty claims only.By following these steps, healthcare providers can effectively address code P8 and ensure proper handling of the claim under investigation.
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