Denial Code 139 means that the claim has been denied because the subscriber is employed by the provider of services and there is a contracted funding agreement in place. This denial code should only be used with Group Code CO. In this article, we will provide a description of Denial Code 139, common reasons for its occurrence, next steps to resolve the denial, tips on how to avoid it in the future, and examples of cases where this denial code may be applied.
2. Description
Denial Code 139 is a specific denial code that indicates a contracted funding agreement between the subscriber and the provider of services. This means that the subscriber is employed by the provider and there is an agreement in place regarding the funding of services. The denial code should only be used with Group Code CO, which stands for Contractual Obligation.
2. Common Reasons
The most common reasons for Denial Code 139 are:
- Employment Relationship: Denial Code 139 is typically triggered when the subscriber is employed by the provider of services. This can occur in situations where the provider is a healthcare organization or facility that employs individuals who also receive services from the same organization.
- Contractual Agreement: Denial Code 139 is used to indicate that there is a contracted funding agreement in place between the subscriber and the provider. This agreement outlines the terms and conditions for the funding of services and may include provisions for coverage limitations, reimbursement rates, or other financial arrangements.
- Group Code CO: Denial Code 139 should only be used with Group Code CO, which signifies a contractual obligation. This indicates that the denial is not due to a coverage limitation or medical necessity, but rather a contractual agreement between the subscriber and the provider.
3. Next Steps
If you receive a denial with Code 139, here are the next steps to resolve the issue:
- Review Contractual Agreement: First, review the contractual agreement between the subscriber and the provider. Ensure that the denial is valid based on the terms outlined in the agreement.
- Contact Provider: If there are any discrepancies or questions regarding the denial, contact the provider directly. Discuss the denial and seek clarification on the specific reasons for the denial.
- Appeal if Necessary: If you believe that the denial is incorrect or unjustified based on the contractual agreement, you may choose to appeal the denial. Prepare any necessary documentation or evidence to support your appeal and submit it to the appropriate party.
- Seek Legal Advice: In some cases, it may be necessary to seek legal advice if there are significant disputes or concerns regarding the contractual agreement or the denial. Consult with an attorney who specializes in healthcare law to understand your rights and options.
4. How To Avoid It
To avoid Denial Code 139 in the future, consider the following tips:
- Review Employment Relationships: Before submitting a claim, ensure that there are no employment relationships between the subscriber and the provider of services. If there is an employment relationship, it is important to understand the implications and potential denial codes that may be applied.
- Understand Contractual Agreements: Familiarize yourself with any contractual agreements that may be in place between the subscriber and the provider. Be aware of the terms and conditions for funding services and any limitations or requirements that may apply.
- Verify Group Code CO: When submitting a claim, double-check that the appropriate Group Code CO is used to indicate a contractual obligation. Using the correct group code can help ensure accurate processing and minimize the risk of denials.
- Communicate with Providers: Maintain open lines of communication with providers to stay informed about any changes or updates to contractual agreements. Regularly review and update your records to reflect any modifications to the agreement.
5. Example Cases
Here are two examples of cases where Denial Code 139 may be applied:
- Example 1: A healthcare provider submits a claim for services rendered to an employee who works for the same organization. The claim is denied with Code 139, indicating that there is a contracted funding agreement in place between the provider and the employee.
- Example 2: A subscriber receives services from a provider with whom they have an employment relationship. The claim is denied with Code 139, as there is a contractual agreement governing the funding of services between the subscriber and the provider.
