Tuesday, June 8, 2010

Insurance denial - CO 27 - Expenses incurred after coverage terminated.

Denial Code : 27 Expenses incurred after coverage terminated. 
How to work on this denial.

This denial is due to the patient's Medicare/other insurance coverage having been terminated (usually voluntary) prior to receiving the services.
To possible correct a claim:
Ensure you have a copy of the patient’s most recently issued Medicare card.
On the Medicare card, verify for which part(s) of Medicare the patient is eligible.
Ensure HIC/ICN numbers are not being transposed (possibly via software) on claims.
If you are a laboratory, radiology department, or other entity to which the patient or their service(s) may have been referred, obtain a copy of the patient's Medicare card and verify the information above.
If any information has been corrected, check beneficiary eligibility for current and previous dates of service by using the IVR.
To avoid this denial in the future, verify the information indicated below:
Ensure you have a copy of the patient’s most recently issued Medicare card.
On the Medicare card, verify for which part(s) of Medicare the patient is eligible.
Check beneficiary eligibility for current and previous dates of service by using the IVR.
If you are a laboratory, radiology department, or other entity to which the patient or their service(s) may have been referred, obtain a copy of the patient's Medicare card from the referring source prior to submitting your claim.
Solution :
Call patient and check whether they have any other insurance coverage,
If Yes -  Go ahead and get all the required details and check beneficiary eligibility and file the claim.
If No  -  Go ahead and bill the patient.

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