Denial Code 229 means that Medicare has not considered the partial charge amount due to the initial claim Type of Bill being 12X. This code is used in the 837 transaction to convey Coordination of Benefits information when the secondary payer’s cost avoidance policy allows providers to bypass claim submission to a prior payer. Below you can find the description, common reasons for denial code 229, next steps, how to avoid it, and examples.
2. Description
Denial Code 229 is a specific code used in the 837 transaction to indicate that Medicare has not considered the partial charge amount. This denial typically occurs when the initial claim Type of Bill is 12X. The purpose of this code is to convey Coordination of Benefits information when the secondary payer’s cost avoidance policy allows providers to bypass claim submission to a prior payer. It is important to understand this code and its implications to effectively address and resolve the denial.
2. Common Reasons
The most common reasons for denial code 229 are:
- Incorrect Type of Bill: One of the main reasons for denial code 229 is submitting the claim with an incorrect Type of Bill. If the initial claim Type of Bill is not 12X, Medicare will not consider the partial charge amount, resulting in denial under code 229.
- Lack of Coordination of Benefits Information: Another common reason for denial code 229 is the absence or incorrect submission of Coordination of Benefits information. If the secondary payer’s cost avoidance policy allows providers to bypass claim submission to a prior payer, it is crucial to include the necessary information in the 837 transaction to avoid denial under code 229.
- Incomplete or Inaccurate Claim Information: Denial code 229 can also occur if the claim contains incomplete or inaccurate information. This can include missing or incorrect patient identifiers, service codes, or other relevant details. It is essential to ensure that all required information is accurately included in the claim to avoid denials.
3. Next Steps
To address denial code 229, follow these next steps:
- Review Type of Bill: First, review the Type of Bill submitted with the claim. Ensure that it is correctly coded as 12X. If it is not, correct the Type of Bill and resubmit the claim.
- Include Coordination of Benefits Information: If the secondary payer’s cost avoidance policy allows providers to bypass claim submission to a prior payer, make sure to include the necessary Coordination of Benefits information in the 837 transaction. This information should accurately convey the coordination of benefits policy and any relevant details.
- Verify Claim Information: Double-check all claim information for completeness and accuracy. Ensure that all required fields are properly filled out and that patient identifiers, service codes, and other relevant details are correct. Make any necessary corrections and resubmit the claim.
- Communicate with Payers: If there is any confusion or disagreement regarding the denial under code 229, reach out to the payers involved. Discuss the specifics of the claim and the reasons for the denial. This communication can help resolve any issues and clarify the necessary steps to address the denial.
4. How To Avoid It
To avoid denial code 229 in the future, follow these steps:
- Understand Type of Bill Requirements: Familiarize yourself with the Type of Bill requirements for Medicare claims. Ensure that you correctly code the Type of Bill as 12X when submitting claims that involve coordination of benefits and partial charge amounts.
- Include Coordination of Benefits Information: If the secondary payer’s cost avoidance policy allows providers to bypass claim submission to a prior payer, make sure to include the necessary Coordination of Benefits information in the 837 transaction. This information should accurately convey the coordination of benefits policy and any relevant details.
- Ensure Complete and Accurate Claim Information: Double-check all claim information for completeness and accuracy. Ensure that all required fields are properly filled out and that patient identifiers, service codes, and other relevant details are correct. Thoroughly review the claim before submission to minimize the risk of denials.
5. Example Cases
Below are two examples of denial code 229:
- Example 1: A provider submits a claim with a Type of Bill other than 12X for a service involving coordination of benefits and a partial charge amount. Medicare denies the claim under code 229, as the Type of Bill does not meet the requirements for consideration of the partial charge amount.
- Example 2: In another scenario, a provider includes incomplete Coordination of Benefits information in the 837 transaction for a claim with a partial charge amount. Medicare denies the claim under code 229 due to the lack of necessary information.
