How To Fix Denial Code 219 | Common Reasons, Next Steps & How To Avoid It

Denial Code 219 means that the adjustment is based on the extent of injury. This code is used when the payer needs to provide information regarding jurisdictional regulations at either the claim level or the line level. In this article, we will explore the description of denial code 219, common reasons for its occurrence, next steps to resolve it, how to avoid it in the future, and provide example cases.

2. Description

Denial Code 219 is used when the adjustment is based on the extent of injury. If the adjustment is at the claim level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier ‘IG’) for jurisdictional regulations. If the adjustment is at the line level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF).

2. Common Reasons

The most common reasons for denial code 219 are:

1. Jurisdictional Regulations: Denial code 219 may occur when the payer needs to provide information regarding jurisdictional regulations. This can happen when the adjustment is at either the claim level or the line level. It is important for providers to understand and comply with these regulations to avoid denials.
2. Incomplete or Inaccurate Information: Denial code 219 may also occur if the claim or line level information provided by the provider is incomplete or inaccurate. It is crucial for providers to ensure that all necessary information is included and accurate to prevent denials.
3. Lack of Documentation: Insufficient or missing documentation to support the extent of injury can lead to denial code 219. Providers should ensure that they have proper documentation to substantiate the extent of injury and support the services billed.
4. Non-Covered Services: Denial code 219 may occur if the services billed are not covered under the patient’s insurance policy. Providers should verify the coverage and benefits of the patient’s insurance plan before providing services to avoid denials.

3. Next Steps

To resolve denial code 219, providers should take the following steps:

1. Review Jurisdictional Regulations: If the adjustment is at the claim level, providers should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier ‘IG’) for jurisdictional regulations. If the adjustment is at the line level, providers should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Understanding and complying with these regulations is essential to address denial code 219.
2. Ensure Complete and Accurate Information: Providers should review the claim or line level information submitted to ensure it is complete and accurate. Any missing or incorrect information should be corrected and resubmitted to the payer.
3. Provide Sufficient Documentation: Providers should ensure that they have proper documentation to support the extent of injury and the services billed. This documentation should be submitted along with the claim to address denial code 219.
4. Verify Coverage and Benefits: Before providing services, providers should verify the coverage and benefits of the patient’s insurance plan. This will help prevent denials due to non-covered services.

4. How To Avoid It

To avoid denial code 219 in the future, providers should follow these steps:

1. Stay Updated on Jurisdictional Regulations: Providers should stay informed about jurisdictional regulations that may impact claim adjustments. Regularly review and understand the regulations to ensure compliance.
2. Double-Check Information: Before submitting a claim, providers should double-check all information to ensure it is complete and accurate. This includes verifying patient demographics, service codes, and any other relevant details.
3. Maintain Proper Documentation: Providers should maintain proper documentation to support the extent of injury and the services billed. This documentation should be organized and easily accessible when needed.
4. Verify Coverage and Benefits: Prior to providing services, providers should verify the coverage and benefits of the patient’s insurance plan. This will help identify any potential non-covered services and allow for appropriate billing or alternative arrangements.

5. Example Cases

Here are two examples of denial code 219:

• Example 1: A provider submits a claim for a specific procedure, but the payer denies it under denial code 219 due to jurisdictional regulations that require additional documentation to support the extent of injury. The provider reviews the regulations, gathers the necessary documentation, and resubmits the claim with the required supporting information.
• Example 2: A provider bills for a service that is not covered under the patient’s insurance plan. The payer denies the claim under denial code 219. To avoid this in the future, the provider verifies the coverage and benefits of the patient’s insurance plan before providing services.

Source: Claim Adjustment Reason Codes