Denial Code 130 means that a claim has been denied due to a claim submission fee. In this article, we will provide a description of denial code 130, common reasons for its occurrence, next steps to resolve the denial, tips on how to avoid it in the future, and examples of denial code 130 cases.
2. Description
Denial Code 130 is a claim adjustment reason code (CARC) that indicates the denial of a claim due to a claim submission fee. This means that the insurance company will not reimburse the provider for the cost of submitting the claim. The fee may be charged by the insurance company for administrative purposes or to cover the costs associated with processing the claim.
2. Common Reasons
The most common reasons for denial code 130 are:
- Claim Submission Fee: Insurance companies may charge a fee for each claim submitted by a healthcare provider. This fee is typically deducted from the reimbursement amount or denied altogether, resulting in denial code 130.
- Incorrect or Incomplete Claim Information: If the claim is missing required information or contains errors, it may be rejected, and denial code 130 will be assigned. This can include missing patient information, incorrect procedure codes, or incomplete documentation.
- Non-Covered Services: If the services rendered are not covered by the patient’s insurance plan, the claim may be denied, and denial code 130 will be applied. In such cases, the claim submission fee is not reimbursed.
- Expired or Inactive Insurance Policy: If the patient’s insurance policy has expired or is inactive at the time of claim submission, denial code 130 may be assigned. The claim submission fee is not reimbursed in these situations.
3. Next Steps
To resolve denial code 130, follow these next steps:
- Review Claim Submission Fee Policy: Familiarize yourself with the insurance company’s policy regarding claim submission fees. Understand the circumstances under which the fee is charged and the process for reimbursement.
- Verify Claim Information: Double-check the claim information for accuracy and completeness. Ensure that all required fields are filled correctly, including patient details, procedure codes, and supporting documentation.
- Contact Insurance Company: If you believe the denial code 130 was assigned in error, contact the insurance company’s provider support. Provide them with the necessary information and documentation to support your claim for reimbursement of the submission fee.
- Appeal the Denial: If the insurance company does not resolve the issue or denies the reimbursement request, you may need to file an appeal. Follow the appeal process outlined by the insurance company, providing any additional documentation or evidence to support your case.
- Update Claim Submission Process: To avoid future denials under code 130, review your claim submission process. Ensure that all necessary information is included, and that claims are thoroughly reviewed before submission to minimize errors and increase the chances of reimbursement.
4. How To Avoid It
To prevent denial code 130 in the future, consider the following tips:
- Understand Insurance Policies: Familiarize yourself with the insurance policies of the patients you serve. Be aware of any claim submission fees and the circumstances under which they are charged.
- Verify Coverage: Before providing services, verify the patient’s insurance coverage and ensure that the services rendered are covered by their plan. This will help avoid denials due to non-covered services.
- Double-Check Claim Information: Take the time to review claim information for accuracy and completeness. Ensure that all required fields are filled correctly and that supporting documentation is included.
- Stay Up-to-Date: Keep yourself informed about any changes or updates to insurance policies and claim submission processes. Regularly review the guidelines provided by insurance companies to ensure compliance.
5. Example Cases
Here are two examples of denial code 130:
- Example 1: A healthcare provider submits a claim for reimbursement, but the insurance company deducts a claim submission fee of $10 from the reimbursement amount, resulting in denial code 130.
- Example 2: A provider submits a claim for a service that is not covered by the patient’s insurance plan. The claim submission fee of $15 is denied, and denial code 130 is assigned.
