Denial Code 239 means that a claim has been denied because it spans eligible and ineligible periods of coverage. This article will provide a description of denial code 239, common reasons for its occurrence, next steps to resolve the denial, tips on how to avoid it in the future, and examples of denial code 239 cases.
2. Description
Denial Code 239 is a claim adjustment reason code (CARC) that indicates a claim has been denied because it spans eligible and ineligible periods of coverage. This means that the services billed on the claim were provided during a time when the patient’s insurance coverage was not active or was not eligible for reimbursement. As a result, the claim cannot be processed and payment will not be made.
2. Common Reasons
The most common reasons for denial code 239 are:
- Terminated Coverage: If a patient’s insurance coverage has been terminated or expired, any services provided during the period of ineligibility will be denied under code 239. This can occur when a patient fails to renew their insurance policy or when coverage is terminated due to non-payment or other reasons.
- Waiting Periods: Some insurance plans have waiting periods before certain services or treatments are covered. If a claim is submitted for services that were provided during a waiting period, it will be denied under code 239.
- Incorrect Effective Dates: Errors in the effective dates of insurance coverage can lead to denials under code 239. This can occur when the dates entered on the claim do not match the dates of coverage specified by the insurance policy.
- Lack of Prior Authorization: Certain services may require prior authorization from the insurance company before they can be covered. If a claim is submitted without the necessary authorization, it may be denied under code 239.
- Policy Exclusions: Insurance policies often have specific exclusions for certain services or treatments. If a claim is submitted for a service that is excluded from coverage, it will be denied under code 239.
3. Next Steps
To resolve denial code 239, follow these next steps:
- Review Claim Details: Carefully review the details of the denied claim, including the dates of service and the patient’s insurance coverage information. Identify any discrepancies or errors that may have contributed to the denial.
- Confirm Coverage Status: Contact the insurance company to verify the patient’s coverage status during the period in question. Determine if there were any gaps or periods of ineligibility that may have led to the denial.
- Rebill Separate Claims: If the claim spans both eligible and ineligible periods of coverage, it may be necessary to separate the services provided during each period into separate claims. This will ensure that only the eligible services are submitted for reimbursement.
- Obtain Prior Authorization: If the denial was due to a lack of prior authorization, work with the healthcare provider to obtain the necessary authorization from the insurance company. Once obtained, resubmit the claim with the proper documentation.
- Correct Errors: If any errors or discrepancies were identified during the review of the claim, correct them and resubmit the claim with the accurate information. This may include updating the effective dates of coverage or providing additional documentation to support the claim.
- Follow Up with Insurance: After resubmitting the claim, follow up with the insurance company to ensure that it is being processed correctly. Address any further questions or concerns they may have and provide any additional information they request.
4. How To Avoid It
To avoid denial code 239 in the future, consider the following tips:
- Verify Coverage Dates: Before providing any services, verify the patient’s insurance coverage dates to ensure that they are eligible for reimbursement. This can help prevent claims from being submitted for services provided during periods of ineligibility.
- Obtain Prior Authorization: For services that require prior authorization, make sure to obtain the necessary approval from the insurance company before providing the service. This will help ensure that the claim is not denied under code 239 due to a lack of authorization.
- Review Policy Exclusions: Familiarize yourself with the patient’s insurance policy and any exclusions that may apply. Avoid providing services that are not covered by the policy to prevent denials under code 239.
- Double-Check Effective Dates: When submitting claims, double-check the effective dates of the patient’s insurance coverage to ensure accuracy. This will help prevent denials due to incorrect dates.
- Stay Up-to-Date with Policy Changes: Keep track of any changes or updates to the patient’s insurance policy. This includes changes to coverage dates, waiting periods, or policy exclusions. Stay informed to avoid denials under code 239.
5. Example Cases
Here are two examples of denial code 239:
- Example 1: A patient’s insurance coverage expired on December 31st, but they received a medical service on January 5th. The claim for this service would be denied under code 239 because it was provided during a period of ineligibility.
- Example 2: A healthcare provider submitted a claim for a service that required prior authorization, but the claim was denied under code 239 because the necessary authorization was not obtained before providing the service.
