Denial Code 210 means that a claim has been denied because pre-certification or authorization was not received in a timely fashion. Below you can find the description, common reasons for denial code 210, next steps, how to avoid it, and examples.
2. Description
Denial Code 210 is a Claim Adjustment Reason Code (CARC) and is described as ‘Payment adjusted because pre-certification/authorization not received in a timely fashion’. This means that the insurance company will not make the payment for the billed service because the necessary pre-certification or authorization was not obtained within the required timeframe. In simpler terms, the claim is not payable until the pre-certification or authorization process is completed.
2. Common Reasons
The most common reasons for denial code 210 are:
- Lack of Pre-Certification: One of the main reasons for denial code 210 is the failure to obtain pre-certification or authorization for the billed service. Insurance plans often require certain procedures or treatments to be pre-approved before they will cover the costs. If the pre-certification process is not completed in a timely manner, the claim may be denied under code 210.
- Missed Deadlines: Insurance companies typically have specific deadlines for submitting pre-certification or authorization requests. If these deadlines are not met, the claim may be denied under code 210. This can happen if the provider or the patient fails to initiate the pre-certification process in a timely fashion or if there are delays in gathering the necessary documentation.
- Incomplete or Inaccurate Information: Denial code 210 can also occur if the pre-certification or authorization request is incomplete or contains inaccurate information. Insurance companies require specific details about the procedure or treatment being requested, including supporting documentation such as medical records or test results. If any of this information is missing or incorrect, the claim may be denied.
- Non-Covered Services: In some cases, denial code 210 may be triggered if the requested service is not covered by the patient’s insurance plan. Insurance companies have specific guidelines regarding what procedures or treatments they will approve and reimburse. If the requested service falls outside of these guidelines, the claim may be denied under code 210.
- Out-of-Network Providers: If the provider performing the service is not in the patient’s insurance network, denial code 210 may be used. Insurance plans often require pre-certification or authorization for out-of-network services, and if this process is not completed, the claim may be denied.
3. Next Steps
You can fix denial code 210 as follows:
- Review Pre-Certification Requirements: Familiarize yourself with the pre-certification or authorization requirements of the patient’s insurance plan. Understand the specific procedures or treatments that require pre-approval and the necessary documentation that needs to be submitted.
- Initiate Pre-Certification Process: As soon as the need for a pre-certification or authorization is identified, initiate the process promptly. Ensure that all required information and documentation are included in the request to avoid any delays or denials.
- Meet Deadlines: Pay close attention to the deadlines set by the insurance company for submitting pre-certification or authorization requests. Make sure to submit the request well in advance to allow for any potential delays or additional information that may be required.
- Provide Complete and Accurate Information: Double-check all the information and documentation included in the pre-certification or authorization request. Ensure that all details are complete and accurate to avoid any denials due to missing or incorrect information.
- Verify Coverage: Before performing any services, verify that the requested procedure or treatment is covered by the patient’s insurance plan. If it is not covered, discuss alternative options with the patient and obtain their consent before proceeding.
4. How To Avoid It
You can prevent denial code 210 in the future as follows:
- Educate Staff: Ensure that your billing and administrative staff are well-informed about the pre-certification or authorization requirements of different insurance plans. Provide training on how to initiate the process, gather the necessary documentation, and meet the deadlines.
- Implement Pre-Certification Checklist: Develop a pre-certification checklist that outlines the steps to be followed and the information required for each insurance plan. This will help ensure that all necessary information is gathered and submitted accurately and on time.
- Communicate with Patients: Clearly communicate to patients the importance of pre-certification or authorization and the potential consequences of not obtaining it in a timely fashion. Encourage them to notify your office as soon as they are aware of the need for a procedure or treatment that requires pre-approval.
- Streamline Documentation Process: Implement systems or software that can help streamline the pre-certification or authorization process. This can include electronic submission of requests and automated reminders for deadlines.
5. Example Cases
Below are two examples of denial code 210:
- Example 1: A patient undergoes a surgical procedure without obtaining the necessary pre-certification from their insurance company. As a result, the claim is denied under code 210, and the patient is responsible for the full payment of the procedure.
- Example 2: A provider submits a claim for a specialized imaging test without including the required supporting documentation for pre-certification. The claim is denied under code 210, and the provider must resubmit the claim with the necessary documentation to obtain reimbursement.
