Denial Code 128 means that the services provided to a newborn are covered under the mother’s allowance. Below you can find the description, common reasons for denial code 128, next steps, how to avoid it, and examples.
2. Description
Denial Code 128 is a specific code that indicates that the services rendered to a newborn are covered under the mother’s allowance. This means that the insurance company will not make a separate payment for the newborn’s services, as they are already included in the coverage provided to the mother. In simpler terms, the claim for the newborn’s services will be denied because they are considered part of the mother’s benefits.
2. Common Reasons
The most common reasons for denial code 128 are:
- Inadequate Documentation: One common reason for denial code 128 is the lack of proper documentation to support the claim for the newborn’s services. Insurance companies require specific documentation, such as the birth certificate or proof of the mother’s coverage, to verify that the services are indeed covered under the mother’s allowance.
- Incorrect Billing: Another reason for denial code 128 is incorrect billing. If the services provided to the newborn are billed separately instead of being included in the mother’s claim, the insurance company may deny the claim for the newborn’s services as they are not eligible for separate reimbursement.
- Lack of Coordination: Denial code 128 can also occur when there is a lack of coordination between the healthcare provider and the insurance company. If the provider fails to communicate that the services rendered are covered under the mother’s allowance, the claim may be denied.
3. Next Steps
To fix denial code 128, you can take the following steps:
- Review Documentation: First, review the documentation submitted with the claim to ensure that it includes the necessary proof of the mother’s coverage and the relationship between the mother and the newborn.
- Coordinate with the Insurance Company: Contact the insurance company to clarify the coverage for the newborn’s services. Provide any additional documentation or information they may require to support the claim.
- Resubmit the Claim: If the denial was due to inadequate documentation or incorrect billing, make the necessary corrections and resubmit the claim with the updated information.
- Appeal the Denial: If you believe that the denial was incorrect or unjustified, you have the option to appeal the decision. Gather any additional evidence or documentation that supports your claim and submit it as part of the appeal process.
4. How To Avoid It
To avoid denial code 128 in the future, consider the following:
- Verify Coverage: Before providing services to a newborn, verify the coverage details with the insurance company. Ensure that the services will be covered under the mother’s allowance and understand any specific requirements or documentation needed.
- Coordinate with the Insurance Company: Communicate with the insurance company to ensure that they are aware of the relationship between the mother and the newborn and that the services will be covered under the mother’s allowance.
- Proper Billing: Ensure that the services provided to the newborn are billed correctly, either as part of the mother’s claim or as a separate line item indicating that they are covered under the mother’s allowance.
- Thorough Documentation: Maintain thorough documentation of the services provided, including any necessary proof of the mother’s coverage and the relationship between the mother and the newborn.
5. Example Cases
Below are two examples of denial code 128:
- Example 1: A healthcare provider submits a claim for the services provided to a newborn, but fails to include the necessary documentation to prove that the services are covered under the mother’s allowance. The claim is denied under code 128.
- Example 2: The insurance company receives a claim for the services provided to a newborn, but the claim is not coordinated with the mother’s claim. As a result, the claim for the newborn’s services is denied under code 128.
