Denial Code 250 means that the attachment or other documentation received was incorrect, and the expected attachment or document is still missing. This denial code requires at least one Remark Code to be provided, which can be either the NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT. In this article, we will provide a description of denial code 250, common reasons for its occurrence, next steps to resolve it, tips on how to avoid it in the future, and examples of denial code 250 cases.
2. Description
Denial Code 250 is a specific Claim Adjustment Reason Code (CARC) that indicates an issue with the attachment or other documentation submitted with a claim. It signifies that the received attachment or document was incorrect, and the expected attachment or document is still missing. To further clarify the denial, at least one Remark Code must be provided, which can be either the NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT. This denial code is used to communicate to the provider that the necessary supporting documentation is either incorrect or incomplete.
2. Common Reasons
The most common reasons for denial code 250 are:
- Incorrect Attachment: One of the main reasons for denial code 250 is when the attachment or other documentation submitted with the claim does not match the requirements set by the payer. This could include submitting the wrong document, missing pages, or providing an attachment that does not support the billed service.
- Missing Attachment: Another common reason for denial code 250 is when the expected attachment or document is missing altogether. This could be due to oversight or failure to include the necessary supporting documentation required by the payer.
- Invalid Format: Denial code 250 may also occur if the attachment or other documentation is not in the correct format specified by the payer. This could include submitting documents in the wrong file type, such as PDF instead of JPEG, or failing to adhere to specific formatting guidelines.
- Incomplete Documentation: If the submitted attachment or other documentation is incomplete, with missing or insufficient information, denial code 250 may be issued. Payers require complete and accurate documentation to support the billed services, and any gaps or omissions can result in a denial.
- Unrecognized Remark Code: Denial code 250 may also occur if the Remark Code provided does not meet the requirements set by the payer. It is essential to ensure that the Remark Code used is appropriate and aligns with the specific denial reason.
3. Next Steps
To resolve denial code 250, follow these next steps:
- Review the Denial Explanation: Carefully review the denial explanation provided by the payer to understand the specific reason for denial code 250. This will help identify the exact issue with the attachment or other documentation.
- Verify Attachment Requirements: Cross-reference the payer’s attachment requirements with the submitted documentation to ensure compliance. Identify any discrepancies or missing elements that may have led to the denial.
- Correct and Resubmit: If the denial was due to an incorrect attachment, missing attachment, invalid format, or incomplete documentation, take the necessary steps to rectify the issue. This may involve obtaining the correct attachment, including any missing pages, converting files to the appropriate format, or ensuring all required information is complete.
- Provide Appropriate Remark Code: If the denial was due to an unrecognized Remark Code, consult the payer’s guidelines to determine the correct Remark Code to use. Ensure that the provided Remark Code accurately reflects the reason for denial code 250.
- Document and Track: Keep a record of all actions taken to address the denial. This includes documenting any corrections made, resubmission dates, and communication with the payer. Tracking the progress will help ensure that the issue is resolved efficiently.
- Follow Up: If the denial persists or further clarification is needed, reach out to the payer’s provider support for assistance. They can provide additional guidance on resolving the denial and offer insights into any specific requirements or documentation needed.
4. How To Avoid It
To avoid denial code 250 in the future, consider the following tips:
- Understand Payer Requirements: Familiarize yourself with the specific attachment requirements of each payer you work with. This includes knowing the acceptable file formats, page limits, and any specific guidelines for supporting documentation.
- Double-Check Documentation: Before submitting a claim, thoroughly review the attachment or other documentation to ensure accuracy and completeness. Verify that all required information is included and that the document supports the billed service.
- Follow Formatting Guidelines: Adhere to the formatting guidelines set by the payer. This may include using the correct file type, ensuring legibility, and organizing the document in a clear and logical manner.
- Implement Quality Control Measures: Establish internal processes to double-check attachments and other documentation before submission. This can involve having a designated team member review the documentation for accuracy and compliance with payer requirements.
- Stay Updated: Regularly monitor and stay informed about any changes or updates to attachment requirements from payers. This will help ensure that your documentation remains in line with the latest guidelines.
5. Example Cases
Below are two examples of denial code 250:
- Example 1: A provider submits a claim for a surgical procedure but fails to include the required operative report as supporting documentation. The claim is denied under code 250, indicating that the expected attachment is missing.
- Example 2: A provider submits a claim for a diagnostic test but includes an outdated version of the test results. The claim is denied under code 250, as the attachment provided does not match the current documentation requirements.
