How To Fix Denial Code 143 | Common Reasons, Next Steps & How To Avoid It

Denial Code 143 means that a portion of the payment has been deferred. Below you can find the description, common reasons for denial code 143, next steps, how to avoid it, and examples.

2. Description

Denial Code 143 is a Claim Adjustment Reason Code (CARC) and is described as ‘Portion of Payment Deferred’. This code indicates that the insurance company has chosen to defer a portion of the payment for the billed service. It means that the claim is not fully payable at the moment and that the deferred amount will need to be addressed separately.

2. Common Reasons

The most common reasons for denial code 143 are:

1. Contractual Agreements: Denial code 143 may occur when there are specific contractual agreements between the healthcare provider and the insurance company. These agreements may outline certain circumstances where a portion of the payment is deferred, such as negotiated rates or specific services that require additional documentation or review.
2. Missing or Incomplete Documentation: If the required documentation or supporting information for the billed service is missing or incomplete, the insurance company may choose to defer a portion of the payment until the necessary documentation is provided. This can include medical records, prior authorization, or other relevant documentation.
3. Review or Investigation: Denial code 143 may also be used when the insurance company needs to conduct a review or investigation into the billed service. This can occur if there are concerns about the medical necessity of the service, potential fraud or abuse, or if additional information is needed to determine the appropriate payment amount.
4. Policy Limitations: Some insurance policies may have limitations or restrictions on certain services or treatment modalities. If the billed service falls within these limitations, the insurance company may choose to defer a portion of the payment until the policy requirements are met or additional information is provided.
5. Coordination of Benefits: In cases where the patient has multiple insurance policies, denial code 143 may be used if there is a need for coordination of benefits. This can occur when the primary insurance company defers a portion of the payment until the secondary insurance company has processed the claim and determined their portion of the payment.

3. Next Steps

You can address denial code 143 as follows:

1. Review the Explanation of Benefits (EOB): Start by reviewing the EOB provided by the insurance company. This will provide details about the specific reasons for the deferred payment and any additional documentation or information required.
2. Submit the Required Documentation: If the denial is due to missing or incomplete documentation, gather the necessary information and submit it to the insurance company. Ensure that all required forms, medical records, or other supporting documentation are included to address the specific concerns raised by the insurance company.
3. Follow Up with the Insurance Company: After submitting the required documentation, follow up with the insurance company to ensure that it has been received and is being reviewed. This will help expedite the process and ensure that the deferred payment is addressed in a timely manner.
4. Appeal if Necessary: If you believe that the denial code 143 was applied in error or if you have additional information to support the claim, consider filing an appeal. Follow the insurance company’s appeal process and provide any relevant documentation or evidence to support your case.
5. Monitor the Claim: Keep track of the status of the claim and any communication with the insurance company. This will help ensure that the deferred payment is resolved and that the claim is processed correctly.

4. How To Avoid It

To avoid denial code 143 in the future, consider the following steps:

1. Ensure Complete Documentation: Make sure that all necessary documentation and supporting information are included when submitting claims. This will help prevent delays or deferral of payment due to missing or incomplete documentation.
2. Verify Policy Limitations: Familiarize yourself with the insurance policies and any limitations or restrictions that may apply to certain services. This will help ensure that claims are submitted correctly and that any potential deferral of payment is anticipated and addressed.
3. Coordinate Benefits: If the patient has multiple insurance policies, ensure that coordination of benefits is properly managed. This includes submitting claims to the primary insurance company first and providing any necessary information to the secondary insurance company to avoid unnecessary deferral of payment.
4. Stay Informed: Keep up-to-date with any changes or updates to insurance policies, billing requirements, or documentation guidelines. This will help ensure that claims are submitted correctly and that any potential deferral of payment is minimized.

5. Example Cases

Below are two examples of denial code 143:

• Example 1: A healthcare provider submits a claim for a specialized procedure that requires additional documentation to support medical necessity. The insurance company defers a portion of the payment until the necessary documentation is provided.
• Example 2: In a case where a patient has both primary and secondary insurance coverage, the primary insurance company defers a portion of the payment until the secondary insurance company has processed the claim and determined their portion of the payment.

Source: Claim Adjustment Reason Codes