How To Fix Denial Code 206 | Common Reasons, Next Steps & How To Avoid It

Denial Code 206 means that a claim has been denied because the National Provider Identifier (NPI) is missing. Below you can find the description, common reasons for denial code 206, next steps, how to avoid it, and examples.

2. Description

Denial Code 206 is a specific denial code that indicates the claim has been denied due to the absence of the National Provider Identifier (NPI). The NPI is a unique identification number assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). It is essential for accurate and efficient processing of healthcare claims. Without the NPI, the claim cannot be properly identified and processed, resulting in denial.

2. Common Reasons

The most common reasons for denial code 206 are:

1. Incomplete Claim Information: One of the primary reasons for denial code 206 is the omission of the NPI from the claim. This can occur if the provider fails to include their NPI on the claim form or if there is an error in entering the NPI.
2. Outdated or Invalid NPI: Denial code 206 may also occur if the NPI provided is outdated or invalid. It is crucial for providers to ensure that their NPI is up to date and accurately entered on the claim form.
3. Incorrect NPI: Another reason for denial code 206 is the submission of an incorrect NPI. This can happen if the provider accidentally enters the wrong NPI or if there is a typographical error in the NPI.
4. Missing NPI for Referring Provider: In some cases, denial code 206 may be triggered if the NPI for the referring provider is missing. It is important to include the NPI of the referring provider when applicable to avoid this denial.
5. Non-Participating Provider: If a provider is not enrolled or participating in the payer’s network, denial code 206 may be issued. Non-participating providers may not have an NPI or may not be recognized by the payer, leading to denial.

3. Next Steps

You can fix denial code 206 as follows:

1. Verify NPI: First, verify that the NPI provided on the claim is correct and up to date. Check for any typographical errors or outdated information. If necessary, update the NPI with the appropriate authorities.
2. Resubmit Claim with Correct NPI: If the denial was due to an incorrect or missing NPI, correct the error and resubmit the claim with the accurate NPI. Ensure that the NPI is entered in the designated field on the claim form.
3. Review Claim Information: Double-check all other claim information for accuracy. Ensure that all required fields are completed and that there are no other errors or omissions that could result in denial.
4. Contact Payer: If you are unsure why the NPI was missing or if you believe the denial was in error, contact the payer’s provider support. Discuss the specifics of the claim and inquire about any additional steps or information required to resolve the denial.
5. Update Provider Systems: Take steps to prevent future denials due to missing NPIs. Implement processes to ensure that the NPI is consistently included on all claims and that it is regularly updated as needed.

4. How To Avoid It

You can prevent denial code 206 in the future as follows:

1. Ensure NPI Accuracy: Regularly review and update your NPI to ensure it is accurate and up to date. This includes notifying the appropriate authorities of any changes in your practice or provider information.
2. Double-Check Claim Information: Before submitting a claim, carefully review all claim information to ensure that the NPI is included and entered correctly. Take the time to verify that all other required fields are completed accurately as well.
3. Train Staff: Educate your billing and administrative staff on the importance of including the NPI on all claims. Provide training on how to accurately enter the NPI and emphasize the significance of this identifier in claim processing.
4. Utilize Electronic Health Record (EHR) Systems: If possible, use an EHR system that automatically populates the NPI field to reduce the risk of human error. This can help ensure that the NPI is consistently included on all claims.

5. Example Cases

Below are two examples of denial code 206:

• Example 1: A healthcare provider submits a claim for a patient’s office visit but accidentally leaves the NPI field blank. As a result, the claim is denied under code 206 due to the missing NPI.
• Example 2: A provider enters an incorrect NPI on a claim for a surgical procedure. The claim is subsequently denied under code 206 because the NPI does not match the provider’s information on record.

Source: Claim Adjustment Reason Codes