Denial Code 142 means that a claim has been denied due to the monthly Medicaid patient liability amount. Below you can find the description, common reasons for denial code 142, next steps, how to avoid it, and examples.
2. Description
Denial Code 142 is a Claim Adjustment Reason Code (CARC) and is described as ‘Monthly Medicaid patient liability amount’. This denial code indicates that the claim has been denied because the patient is responsible for a monthly liability amount as determined by their Medicaid coverage. The insurance company will not make the payment for the billed service as the patient is required to pay their share of the cost.
2. Common Reasons
The most common reasons for denial code 142 are:
- Inadequate Medicaid Coverage: Denial code 142 may occur if the patient’s Medicaid coverage does not include the specific service or treatment that was billed. Medicaid coverage varies by state and may have limitations or exclusions for certain procedures or medications. If the service is not covered, the patient will be responsible for the liability amount.
- Incorrect Patient Information: Errors in patient information, such as incorrect Medicaid identification numbers or demographic details, can result in denial code 142. It is crucial to ensure accurate and up-to-date patient information is provided when submitting claims to Medicaid.
- Missing or Incomplete Documentation: Medicaid may require specific documentation to support the medical necessity of a service or treatment. If the required documentation is missing or incomplete, the claim may be denied under code 142. Providers should ensure that all necessary documentation is included with the claim submission.
- Non-Compliance with Medicaid Guidelines: Medicaid has specific guidelines and requirements for the provision of healthcare services. If the provider fails to comply with these guidelines, such as obtaining prior authorization or following specific billing procedures, the claim may be denied under code 142.
- Exceeded Medicaid Coverage Limits: Medicaid coverage often has limits on the number of visits or treatments allowed within a specific time period. If the patient has already reached their coverage limit, any additional services will be denied under code 142, and the patient will be responsible for the liability amount.
3. Next Steps
You can address denial code 142 as follows:
- Review Medicaid Coverage: Verify the patient’s Medicaid coverage to ensure that the service or treatment is included in their plan. If the service is not covered, inform the patient of their liability amount and discuss alternative options for payment or alternative treatments that may be covered.
- Double-Check Patient Information: Ensure that all patient information, including Medicaid identification numbers and demographic details, is accurate and up-to-date. Correct any errors or missing information before resubmitting the claim.
- Complete Documentation: Ensure that all required documentation supporting the medical necessity of the service or treatment is included with the claim submission. Review Medicaid guidelines to ensure compliance with any specific documentation requirements.
- Comply with Medicaid Guidelines: Familiarize yourself with Medicaid guidelines and requirements for the provision of healthcare services. Obtain any necessary prior authorizations and follow the correct billing procedures to avoid denials under code 142.
- Monitor Coverage Limits: Keep track of the patient’s Medicaid coverage limits to ensure that they have not exceeded the allowed number of visits or treatments. If the patient has reached their limit, discuss alternative options or payment arrangements for any additional services.
4. How To Avoid It
You can prevent denial code 142 in the future by following these steps:
- Verify Medicaid Coverage: Before providing any services or treatments, verify the patient’s Medicaid coverage to ensure that the specific service or treatment is covered. If it is not covered, discuss alternative options with the patient.
- Ensure Accurate Patient Information: Double-check all patient information, including Medicaid identification numbers and demographic details, to ensure accuracy. Update any outdated or incorrect information in your records.
- Complete Documentation Requirements: Familiarize yourself with Medicaid’s documentation requirements for different services and treatments. Ensure that all necessary documentation is complete and included with the claim submission.
- Comply with Medicaid Guidelines: Stay up-to-date with Medicaid guidelines and requirements for the provision of healthcare services. Obtain any required prior authorizations and follow the correct billing procedures.
- Monitor Coverage Limits: Keep track of the patient’s Medicaid coverage limits, especially for services or treatments with limitations. Inform the patient when they are approaching their coverage limit to discuss alternative options.
5. Example Cases
Below are two examples of denial code 142:
- Example 1: A patient receives a dental procedure that is not covered by their Medicaid plan. The claim is denied under code 142, and the patient is responsible for the monthly liability amount associated with the procedure.
- Example 2: A provider submits a claim without including the required documentation to support the medical necessity of a specific treatment. The claim is denied under code 142, and the provider must resubmit the claim with the complete documentation.
