Denial Code 144 means that the claim has been denied due to an incentive adjustment, such as a preferred product or service. In this article, we will provide a detailed description of denial code 144, 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 144 cases.
2. Description
Denial Code 144 is an incentive adjustment denial code. It indicates that the claim has been denied because the billed service or product is not eligible for reimbursement or is not the preferred option according to the insurance company’s policies. This denial code is often used when a provider submits a claim for a service or product that does not meet the insurer’s criteria for coverage or reimbursement.
2. Common Reasons
The most common reasons for denial code 144 are:
- Non-Preferred Product or Service: Denial code 144 may occur when the provider submits a claim for a product or service that is not listed as a preferred option by the insurance company. This could be due to the availability of alternative options that are considered more cost-effective or medically appropriate.
- Out-of-Network Provider: If the provider is not in the insurance company’s network, denial code 144 may be applied. Insurance plans often have preferred networks of providers, and claims from out-of-network providers may be denied or subject to different reimbursement rates.
- Missing or Incomplete Documentation: Insufficient or incomplete documentation supporting the medical necessity or appropriateness of the billed service or product can lead to denial code 144. The insurance company requires proper documentation to ensure that the service or product meets their criteria for coverage.
- Expired or Invalid Authorization: If the provider did not obtain the necessary authorization or if the authorization has expired, denial code 144 may be used. Insurance plans often require pre-authorization for certain services or products, and claims without proper authorization may be denied.
- Policy Limitations: Denial code 144 may be applied if the claim exceeds the policy limitations set by the insurance company. This could include limitations on the frequency or duration of certain services or products.
3. Next Steps
To resolve denial code 144, follow these next steps:
- Review the Denial Explanation: Carefully review the denial explanation provided by the insurance company. Understand the specific reason for the denial and any additional information or documentation required to support the claim.
- Appeal the Denial: If you believe the denial was incorrect or unjustified, consider appealing the decision. Gather any necessary documentation or additional information to support the appeal and submit it to the insurance company within the specified timeframe.
- Communicate with the Insurance Company: Contact the insurance company’s provider support to discuss the denial and seek clarification if needed. Understand their policies and requirements to ensure future claims meet their criteria for coverage.
- Update Documentation Practices: Improve your documentation practices to ensure that all necessary information is included in future claims. This includes documenting the medical necessity of the service or product, obtaining proper authorizations, and adhering to any policy limitations set by the insurance company.
- Consider Negotiation: In some cases, it may be possible to negotiate with the insurance company to reach a resolution. This could involve discussing alternative options or demonstrating the medical necessity of the service or product.
4. How To Avoid It
To avoid denial code 144 in the future, consider the following tips:
- Verify Coverage and Preferred Options: Before providing a service or product, verify the patient’s insurance coverage and check if the specific service or product is listed as a preferred option. This can help prevent denials due to non-preferred options.
- Join Insurance Networks: If possible, become an in-network provider for insurance companies. This can help ensure that claims are processed smoothly and reduce the likelihood of denials due to out-of-network status.
- Obtain Proper Authorization: Understand the insurance company’s authorization requirements and obtain the necessary authorizations before providing services or products. This can help prevent denials related to missing or expired authorizations.
- Improve Documentation Practices: Enhance your documentation practices to ensure that all necessary information is included in the claim. This includes documenting the medical necessity of the service or product and providing any supporting documentation as required.
- Stay Informed: Regularly review and stay updated on the insurance company’s policies, coverage criteria, and limitations. This can help ensure that claims are submitted correctly and meet the insurer’s requirements.
5. Example Cases
Here are two examples of denial code 144:
- Example 1: A provider submits a claim for an expensive brand-name medication, but the insurance company’s policy only covers the generic equivalent. The claim is denied under denial code 144 due to the non-preferred product.
- Example 2: An out-of-network provider performs a specialized procedure without obtaining prior authorization. The claim is denied under denial code 144 because the provider is not in the insurance company’s network and did not obtain proper authorization.
