Denial Code 208 means that the National Provider Identifier (NPI) provided on the claim does not match the information on file with the insurance company. Below you can find the description, common reasons for denial code 208, next steps, how to avoid it, and examples.
2. Description
Denial Code 208 is a specific denial code that indicates the National Provider Identifier (NPI) provided on the claim does not match the information on file with the insurance company. The NPI is a unique identification number assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). This denial code suggests that there is an issue with the provider’s NPI, which could include incorrect or outdated information.
2. Common Reasons
The most common reasons for denial code 208 are:
- Inaccurate NPI: One of the main reasons for denial code 208 is when the NPI provided on the claim is incorrect. This could be due to a typographical error or outdated information. It is essential for providers to ensure that they are using the correct and up-to-date NPI when submitting claims.
- Provider Not Enrolled: Another reason for denial code 208 is when the provider is not enrolled with the insurance company or is not recognized as a valid healthcare provider. This could occur if the provider’s NPI is not registered with the insurance company or if the provider’s enrollment has expired or been terminated.
- Invalid NPI Format: Denial code 208 may also occur if the NPI provided on the claim does not adhere to the required format. The NPI should consist of ten digits and should not contain any letters or special characters. If the NPI is not formatted correctly, the claim may be denied.
- Mismatched NPI: In some cases, denial code 208 may occur if the NPI provided on the claim does not match the information on file with the insurance company. This could be due to a discrepancy in the provider’s NPI between different systems or databases.
3. Next Steps
You can fix denial code 208 as follows:
- Verify NPI: The first step is to verify the NPI that was provided on the claim. Check for any typographical errors or outdated information. Ensure that the NPI is correct and up-to-date.
- Contact Insurance Company: If the NPI is correct and you believe that the denial was in error, contact the insurance company’s provider support. Provide them with the correct NPI and any supporting documentation to resolve the issue.
- Update Provider Information: If the NPI is incorrect or outdated, update your provider information with the insurance company. This may involve updating your enrollment or contacting the appropriate authorities to correct any discrepancies in your NPI.
- Resubmit Claim: Once the NPI issue has been resolved, resubmit the claim with the correct NPI and any necessary documentation. Ensure that the claim is accurately completed and meets all the requirements of the insurance company.
- Follow Up: After resubmitting the claim, follow up with the insurance company to ensure that the issue has been resolved and that the claim is being processed correctly.
4. How To Avoid It
You can prevent denial code 208 in the future as follows:
- Double-Check NPI: Before submitting any claims, double-check the NPI to ensure that it is correct and up-to-date. Verify the NPI with the appropriate authorities and update any outdated information.
- Enrollment Status: Regularly check your enrollment status with the insurance company to ensure that you are still recognized as a valid healthcare provider. Renew your enrollment if necessary and notify the insurance company of any changes in your provider information.
- Format Compliance: Ensure that the NPI provided on the claim adheres to the required format. The NPI should consist of ten digits and should not contain any letters or special characters.
- Consistent NPI: Maintain consistency in your NPI across different systems and databases. Regularly reconcile any discrepancies to ensure that the NPI provided on the claim matches the information on file with the insurance company.
5. Example Cases
Below are two examples of denial code 208:
- Example 1: A healthcare provider submits a claim with an NPI that contains a typographical error. The insurance company denies the claim under denial code 208, as the NPI does not match the information on file.
- Example 2: A provider’s enrollment with an insurance company expires, but they continue to submit claims using their outdated NPI. The insurance company denies the claims under denial code 208, as the provider is no longer recognized as a valid healthcare provider.
