How To Fix Denial Code 200 | Common Reasons, Next Steps & How To Avoid It

Denial Code 200 means that expenses incurred during a lapse in coverage have been denied. Below you can find the description, common reasons for denial code 200, next steps, how to avoid it, and examples.

2. Description

Denial Code 200 is a Claim Adjustment Reason Code (CARC) and is described as ‘Expenses incurred during lapse in coverage’. This denial code indicates that the insurance company will not make payment for the billed services because they were incurred during a period when the patient’s insurance coverage was not active. In simpler terms, the claim is not payable because the patient did not have insurance coverage at the time the services were provided.

2. Common Reasons

The most common reasons for denial code 200 are:

1. Lapsed Insurance Coverage: Denial code 200 occurs when the patient’s insurance coverage has lapsed or expired. This can happen due to non-payment of premiums, termination of the insurance policy, or failure to renew the coverage. If services are rendered during this period, the insurance company will deny the claim as the patient was not covered at the time.
2. Missed Premium Payments: If the patient fails to pay their insurance premiums on time, their coverage may lapse. If services are received during the period of non-payment, the claim will be denied under denial code 200.
3. Waiting Periods: Some insurance policies have waiting periods before coverage becomes effective. If services are received during this waiting period, the claim may be denied under denial code 200.
4. Incorrect Effective Dates: Errors in recording the effective dates of insurance coverage can lead to denials under code 200. If the recorded effective date does not align with the date of service, the claim may be denied as the patient was not covered at the time.
5. Policy Exclusions: Certain insurance policies may have specific exclusions for certain services or conditions. If services are provided that fall under these exclusions, the claim may be denied under denial code 200.

3. Next Steps

You can address denial code 200 as follows:

1. Verify Insurance Coverage: Before providing any services, verify the patient’s insurance coverage to ensure it is active and in effect. This can be done by contacting the insurance company or using an online portal provided by the insurer.
2. Communicate with the Patient: If denial code 200 is received, inform the patient about the denial and explain that the services were provided during a period when their insurance coverage was not active. Discuss the options available to resolve the situation, such as self-payment or seeking alternative insurance coverage.
3. Appeal the Denial: If you believe the denial was in error, gather any supporting documentation that proves the patient had active insurance coverage at the time the services were provided. This may include proof of premium payments, policy documents, or correspondence with the insurance company. Submit an appeal with this documentation to challenge the denial.
4. Offer Self-Payment Options: If the patient does not have alternative insurance coverage and is unable to appeal the denial, discuss self-payment options with them. Provide information on payment plans, discounts, or financial assistance programs that may be available to help them cover the cost of the services.
5. Update Insurance Information: Review your processes for verifying insurance coverage and ensure that accurate and up-to-date information is recorded for each patient. This includes effective dates, policy numbers, and any waiting periods or exclusions that may apply.

4. How To Avoid It

You can prevent denial code 200 in the future by taking the following steps:

1. Verify Insurance Coverage: Before providing any services, verify the patient’s insurance coverage to ensure it is active and in effect. Double-check the effective dates and any waiting periods or exclusions that may apply.
2. Remind Patients of Premium Payments: Educate patients about the importance of paying their insurance premiums on time to avoid lapses in coverage. Provide reminders or resources to help them stay on top of their premium payments.
3. Review Policy Exclusions: Familiarize yourself with the insurance policies you work with and understand any exclusions that may apply. This will help you avoid providing services that are not covered by the patient’s insurance.
4. Update Insurance Information: Regularly update and verify the insurance information of your patients. This includes effective dates, policy numbers, and any waiting periods or exclusions that may apply. Keep accurate records to avoid denials due to incorrect or outdated information.

5. Example Cases

Below are two examples of denial code 200:

• Example 1: A patient visits a healthcare provider for a medical procedure during a period when their insurance coverage has lapsed due to non-payment of premiums. The claim is denied under denial code 200 as the services were provided during a lapse in coverage.
• Example 2: A patient receives treatment for a pre-existing condition that is specifically excluded from their insurance policy. The claim is denied under denial code 200 as the services fall under a policy exclusion.

Source: Claim Adjustment Reason Codes