Decoding Denials for Healthcare RCM Teams
Denial codes are important indicators of why a claim is getting rejected, and for RCM teams, understanding what unique codes represent is crucial. With each code representing a reason as to why you are not recovering certain revenue, the ability to decipher them on the fly can help you pinpoint operational inefficiencies, increase revenue, and improve overall performance.
Our Decoding Denials series outlines different denial codes, what they mean, and how your team can mitigate and respond to them. In this blog, we’ll dive into code CO-29. Let’s get started!
What is Denial Code CO-29
Definition: Denial Code CO-29 means that the claim was denied because the time limit for submitting the claim has expired. Meaning, this code is used when the claim is submitted after the permitted time frame.
Common Cause of Denial Code CO-29
Cause: Denial Code CO-29 can occur as a result of multiple different mishaps. These can include:
- Claim was not submitted within the time limit
- Coding error
- Missing documentation
- Lack of prior-authorization
- Incorrect information about payer rules
- Miscommunication with patient
- Technical errors (for example, a system being down)
Example: Different payers may have different timely filing limits. For example, some payers enforce a 1 year rule for filing claims, but another payer may have a 90 day rule or a 6 month rule. If these rules are not kept organized and top of mind, they can easily be mixed up and not filed. If you think you have 1 year to file a claim but the specific payer actually has a 6 month limit, you’ll receive this denial code when you file after 6 months.
Responsibility: In this case, the portion of the code that says “CO” refers to the fact that this is a contractual obligation between the payer and provider. This is why it’s so important to have accurate documentation in place to keep track of ever-changing payer rules and regulations.
Ways to Mitigate Denial Code CO-29
Prevention: Denial Code CO-29 be avoided by taking precautions such as:
- Timely submission of claims
- Optimized claim submission process to mitigate errors
- Staying up to date with payer policies and changes
- Automated and alerting to ensure claim accuracy and timely submission
How to Address Denial Code CO-29
Response: If you receive Denial Code CO-29, there are a few steps you can take to contact the payer and/or submit an appeal.
- Compare the date submitted with the payer’s timely filing limit to determine whether or not the claim was submitted during that time frame.
- Investigate why the claim was not submitted in time
- Reach out to the payer to discuss your options, if you would like the claim to be reconsidered, make sure you have any supporting documentation handy
- Decide if you would like to submit an appeal
- Continue to monitor the claim’s progress
How Adonis Can Help
An intelligent RCM platform like Adonis can ensure that you are up-to-date on ever-changing payer rules and regulations. Adonis Intelligence’s automations and real-time alerts can ensure accurate and timely submission of claims, preventing denial code CO-29.
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