How To Fix Denial Code 251 | Common Reasons, Next Steps & How To Avoid It

Denial Code 251 means that the attachment or other documentation received for a claim was incomplete or deficient. This means that the necessary information needed to process the claim is still missing. In order to resolve this denial, specific steps need to be taken. Below you can find a detailed description of denial code 251, common reasons for its occurrence, next steps to fix it, how to avoid it in the future, and examples.

2. Description

Denial Code 251 is a claim adjustment reason code that indicates that the attachment or other documentation submitted with a claim is incomplete or deficient. This means that the insurance company requires additional information in order to process the claim. The 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. It is important to provide the missing information to ensure the claim can be properly processed.

2. Common Reasons

The most common reasons for denial code 251 are:

1. Incomplete Attachments: One of the main reasons for denial code 251 is when the attachments or other required documentation are missing or incomplete. This could include medical records, invoices, or any other supporting documents that are necessary for the claim to be processed. Without the complete documentation, the insurance company cannot properly assess the claim and will deny it.
2. Deficient Information: Another reason for denial code 251 is when the submitted documentation does not contain all the necessary information required by the insurance company. This could include missing patient information, provider information, or details about the services rendered. Incomplete or deficient information can lead to a denial as the insurance company cannot accurately evaluate the claim without all the required data.
3. Incorrect Format: Denial code 251 can also occur if the attachments or other documentation are not submitted in the correct format specified by the insurance company. Each insurance company may have specific requirements for how attachments should be submitted, such as file format, file size, or naming conventions. Failure to adhere to these guidelines can result in a denial.
4. Missing Remark Codes: Denial code 251 requires at least one remark code to be provided to explain the reason for the denial. If the remark code is missing or not provided correctly, the claim may be denied under code 251. It is important to include the appropriate remark code to provide clarity on why the claim was denied.

3. Next Steps

To fix denial code 251, the following steps should be taken:

1. Review the Denial Letter: Carefully review the denial letter received from the insurance company. The letter should provide specific details about the missing or deficient documentation. Pay close attention to any remark codes provided, as they will indicate the specific reason for the denial.
2. Identify the Missing Information: Based on the denial letter and remark codes, identify the specific information that is missing or deficient. This could include medical records, invoices, or any other required documentation. Make a list of the missing information to ensure that all necessary documents are obtained.
3. Gather the Missing Documentation: Contact the necessary parties, such as healthcare providers or other relevant sources, to obtain the missing documentation. Ensure that all required information is complete and accurate before resubmitting the claim.
4. Include Remark Codes: When resubmitting the claim, make sure to include the appropriate remark codes to explain the reason for the denial and the steps taken to rectify the issue. This will provide clarity to the insurance company and help expedite the processing of the claim.
5. Follow Up: After resubmitting the claim, follow up with the insurance company to ensure that the missing documentation has been received and that the claim is being processed. This will help avoid any further delays or denials.

4. How To Avoid It

To avoid denial code 251 in the future, consider the following steps:

1. Review Documentation Requirements: Familiarize yourself with the documentation requirements of each insurance company you work with. Understand what attachments are necessary for different types of claims and ensure that all required information is included.
2. Double-Check Information: Before submitting a claim, double-check that all required information is complete and accurate. Verify patient information, provider information, and any other relevant details. This will help prevent denials due to missing or deficient information.
3. Follow Submission Guidelines: Adhere to the submission guidelines provided by each insurance company. Ensure that attachments are submitted in the correct format, file size, and naming conventions specified by the insurer. This will help avoid denials based on incorrect format.
4. Include Remark Codes: When submitting a claim, make sure to include the appropriate remark codes to provide clarity on the claim and any supporting documentation. This will help the insurance company understand the claim and reduce the chances of denial.

5. Example Cases

Below are two examples of denial code 251:

• Example 1: A healthcare provider submits a claim for a surgical procedure but fails to include the necessary operative report as an attachment. The claim is denied under code 251, indicating that the attachment is incomplete or deficient.
• Example 2: A pharmacy submits a claim for a prescription medication but does not include the required documentation, such as a prior authorization form. The claim is denied under code 251, as the necessary attachment is missing.

Source: Claim Adjustment Reason Codes