Denial Code 192 means that a non-standard adjustment code from a paper remittance is being used. This code is typically used by providers or payers when providing Coordination of Benefits information to another payer in the 837 transaction. Denial Code 192 is specifically used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, such as Deductible, Coinsurance, and Co-payment.
2. Description
Denial Code 192 is a non-standard adjustment code that is used in the context of providing Coordination of Benefits information. It is specifically used in the 837 transaction when there is a need to communicate information that cannot be mapped to an existing Claims Adjustment Reason Code. This code is typically used when there are unique circumstances or specific requirements that cannot be addressed by the standard codes.
2. Common Reasons
The common reasons for Denial Code 192 are:
- Non-Standard Situations: Denial Code 192 is used when there are unique circumstances or specific requirements that cannot be addressed by the standard Claims Adjustment Reason Codes. This could include situations where there are complex coordination of benefits arrangements or specific contractual agreements between payers and providers.
- Unmapped Codes: Denial Code 192 is used when there is a need to communicate information that cannot be reasonably mapped to an existing Claims Adjustment Reason Code. This could be due to the use of non-standard codes or codes that are specific to a particular payer or provider.
- Coordination of Benefits: Denial Code 192 is often used in the context of providing Coordination of Benefits information. This could include situations where multiple payers are involved and there is a need to communicate the order in which benefits should be applied or the specific amounts that should be paid by each payer.
3. Next Steps
If you receive Denial Code 192, the next steps to take are:
- Review the Explanation of Benefits (EOB): Carefully review the EOB or paper remittance advice to understand the specific reason for the denial. Look for any additional information or instructions provided by the payer.
- Contact the Payer: If the reason for the denial is not clear or if you need further clarification, contact the payer directly. They will be able to provide more information about the specific requirements or circumstances that led to the use of Denial Code 192.
- Coordinate with Other Payers: If Denial Code 192 is related to Coordination of Benefits, reach out to the other payers involved to ensure that the necessary information is communicated accurately. This may involve providing additional documentation or coordinating the order in which benefits should be applied.
- Consider Professional Assistance: If you are unsure about how to address Denial Code 192 or if it is causing significant delays or financial impact, consider seeking professional assistance. A healthcare consultant or billing specialist can help navigate the complexities of the coordination of benefits process and ensure that the necessary information is communicated effectively.
4. How To Avoid It
To avoid Denial Code 192 in the future, consider the following steps:
- Understand Payer Requirements: Familiarize yourself with the specific requirements and guidelines of each payer you work with. This includes understanding their coordination of benefits policies and any non-standard codes or processes they may use.
- Communicate Clearly: When submitting claims or providing coordination of benefits information, ensure that the information is clear, accurate, and complete. This includes using the appropriate codes and providing any necessary supporting documentation.
- Stay Updated: Keep up-to-date with any changes or updates to payer requirements or coordination of benefits processes. This may involve regularly reviewing payer communications, attending training sessions, or consulting with industry resources.
- Seek Professional Advice: If you are unsure about how to navigate the coordination of benefits process or if you frequently encounter Denial Code 192, consider seeking professional advice. A healthcare consultant or billing specialist can provide guidance and help ensure that your claims and coordination of benefits information are submitted correctly.
5. Example Cases
Here are two examples of Denial Code 192:
- Example 1: A provider submits a claim to a secondary payer for a service that is not covered by the primary payer. The secondary payer uses Denial Code 192 to indicate that the service is not eligible for reimbursement based on the coordination of benefits rules.
- Example 2: A provider submits a claim to a payer using a non-standard code to indicate a specific contractual agreement. The payer uses Denial Code 192 to communicate that the code cannot be mapped to an existing Claims Adjustment Reason Code.
