How To Fix Denial Code 135 | Common Reasons, Next Steps & How To Avoid It

Denial Code 135 means that interim bills cannot be processed. This denial code indicates that the insurance company is unable to process and pay for interim bills submitted by the healthcare provider. In this article, we will explore the description of denial code 135, common reasons for its occurrence, next steps to resolve the denial, how to avoid it in the future, and provide examples of denial code 135 cases.

2. Description

Denial Code 135 is a claim adjustment reason code (CARC) that signifies that interim bills cannot be processed. Interim bills are typically submitted by healthcare providers for services or treatments that are ongoing or require multiple visits. However, for various reasons, the insurance company is unable to process these interim bills, resulting in denial code 135. This denial code indicates that the claim for the interim bill cannot be paid at the current time.

2. Common Reasons

The most common reasons for denial code 135 are:

1. Lack of Documentation: One of the common reasons for denial code 135 is the lack of proper documentation accompanying the interim bill. Insurance companies require detailed documentation to support the need for ongoing or multiple visits. Without sufficient documentation, the insurance company may deny the claim.
2. Missing Information: In some cases, the interim bill may be missing essential information, such as patient identifiers, service codes, or dates of service. This missing information can lead to denial code 135 as the insurance company cannot process the bill without complete and accurate information.
3. Incorrect Coding: Incorrect coding of the services provided in the interim bill can also result in denial code 135. If the services are coded incorrectly or do not align with the patient’s medical condition, the insurance company may deny the claim.
4. Policy Limitations: Some insurance policies have limitations on the number of visits or treatments covered within a specific time frame. If the interim bill exceeds these limitations, the insurance company may deny the claim under denial code 135.
5. Preauthorization Requirements: Certain healthcare services or treatments may require preauthorization from the insurance company. If the interim bill does not have the necessary preauthorization, the claim may be denied under denial code 135.

3. Next Steps

To resolve denial code 135, the following steps can be taken:

1. Review Documentation: Carefully review the documentation accompanying the interim bill. Ensure that all necessary documentation is included and clearly supports the need for ongoing or multiple visits.
2. Check for Missing Information: Double-check the interim bill for any missing information, such as patient identifiers, service codes, or dates of service. Complete any missing information before resubmitting the claim.
3. Verify Coding Accuracy: Verify that the services provided in the interim bill are coded correctly and align with the patient’s medical condition. If any coding errors are identified, correct them before resubmitting the claim.
4. Check Policy Limitations: Review the patient’s insurance policy to determine if there are any limitations on the number of visits or treatments covered. If the interim bill exceeds these limitations, consider discussing alternative payment options with the patient or seeking preauthorization from the insurance company.
5. Obtain Preauthorization: If the interim bill requires preauthorization, ensure that the necessary preauthorization is obtained from the insurance company before resubmitting the claim.
6. Resubmit the Claim: Once all necessary steps have been taken to address the reasons for denial code 135, resubmit the claim with the updated documentation, accurate coding, and any required preauthorization.

4. How To Avoid It

To avoid denial code 135 in the future, consider the following measures:

1. Thorough Documentation: Ensure that all interim bills are accompanied by thorough and detailed documentation that supports the need for ongoing or multiple visits. Include relevant medical records, progress notes, and any other pertinent information.
2. Complete Information: Double-check that all necessary information, including patient identifiers, service codes, and dates of service, is included in the interim bill. Verify the accuracy of the information before submitting the claim.
3. Accurate Coding: Assign accurate and appropriate service codes to the services provided in the interim bill. Regularly train and educate coding staff to ensure they are up to date with the latest coding guidelines.
4. Policy Review: Familiarize yourself with the patient’s insurance policy and any limitations on the number of visits or treatments covered. Be mindful of these limitations when submitting interim bills.
5. Preauthorization Process: Understand the preauthorization requirements for specific healthcare services or treatments. Ensure that all necessary preauthorizations are obtained before submitting the interim bill.

5. Example Cases

Here are two examples of denial code 135:

• Example 1: A healthcare provider submits an interim bill for a patient undergoing physical therapy sessions. However, the documentation accompanying the bill does not clearly demonstrate the medical necessity of the ongoing therapy. As a result, the claim is denied under denial code 135.
• Example 2: A provider submits an interim bill for a patient who has exceeded the maximum number of covered visits for a specific treatment within a given time frame. The insurance company denies the claim under denial code 135 due to policy limitations.

Source: Claim Adjustment Reason Codes