How To Fix Denial Code 177 | Common Reasons, Next Steps & How To Avoid It

Denial Code 177 means that a claim has been denied because the patient has not met the required eligibility requirements. Below you can find the description, common reasons for denial code 177, next steps, how to avoid it, and examples.

2. Description

Denial Code 177 is a Claim Adjustment Reason Code (CARC) and is described as ‘Patient has not met the required eligibility requirements’. This denial code indicates that the patient does not meet the necessary criteria to receive coverage for the billed service. It could be due to various reasons such as lack of insurance coverage, expired insurance, or failure to meet specific eligibility criteria set by the insurance company.

2. Common Reasons

The most common reasons for denial code 177 are:

1. Lack of Insurance Coverage: Patients who do not have active insurance coverage at the time of service may receive denial code 177. This could be due to the termination of their insurance policy, failure to renew coverage, or gaps in coverage.
2. Expired Insurance: If the patient’s insurance policy has expired, they may not meet the eligibility requirements for coverage. This can result in denial code 177 for claims submitted after the expiration date.
3. Failure to Meet Specific Eligibility Criteria: Some insurance plans have specific eligibility criteria that patients must meet to receive coverage for certain services. If the patient does not meet these criteria, their claim may be denied under code 177.
4. Incorrect or Incomplete Patient Information: Denial code 177 can also occur if there are errors or missing information in the patient’s demographic or insurance details. Inaccurate information can lead to the patient being deemed ineligible for coverage.
5. Non-Participating Provider: If the healthcare provider is not in-network or does not have a contract with the patient’s insurance company, the claim may be denied under code 177. In such cases, the patient may be responsible for the full cost of the service.

3. Next Steps

You can address denial code 177 by following these steps:

1. Verify Patient’s Insurance Coverage: Confirm the patient’s insurance coverage and eligibility status. Ensure that their policy is active and that they meet the necessary requirements for coverage.
2. Review Patient Information: Double-check the accuracy and completeness of the patient’s demographic and insurance information. Correct any errors or missing details that may have contributed to the denial.
3. Contact the Insurance Company: Reach out to the patient’s insurance company to understand the specific eligibility requirements that were not met. Discuss the denial and seek clarification on what steps can be taken to rectify the situation.
4. Appeal the Denial: If you believe the denial was in error or if there are extenuating circumstances, consider filing an appeal with the insurance company. Provide any necessary documentation or additional information to support the claim’s validity and demonstrate that the patient meets the eligibility requirements.
5. Explore Alternative Payment Options: If the denial is upheld and the patient is responsible for the cost of the service, work with them to explore alternative payment options. This could include setting up a payment plan or discussing financial assistance programs that may be available.

4. How To Avoid It

To avoid denial code 177 in the future, consider the following steps:

1. Verify Insurance Coverage: Before providing services, verify the patient’s insurance coverage and eligibility. Ensure that their policy is active and that they meet the necessary requirements for coverage.
2. Update Patient Information: Regularly update and maintain accurate patient demographic and insurance information. This includes verifying insurance policy details, such as expiration dates, to avoid denials due to expired coverage.
3. Understand Eligibility Criteria: Familiarize yourself with the specific eligibility criteria set by different insurance companies. Ensure that patients meet these requirements before providing services that may not be covered.
4. Participate in Insurance Networks: If possible, become a participating provider with various insurance networks. This will help ensure that your services are covered by a wider range of insurance plans and reduce the likelihood of denials under code 177.

5. Example Cases

Below are two examples of denial code 177:

• Example 1: A patient visits a healthcare provider without active insurance coverage. The claim is subsequently denied under code 177, as the patient does not meet the required eligibility requirements for coverage.
• Example 2: A patient’s insurance policy expires, but they continue to receive services without renewing their coverage. Any claims submitted after the expiration date would be denied under code 177.

Source: Claim Adjustment Reason Codes