How To Fix Denial Code 252 | Common Reasons, Next Steps & How To Avoid It

Denial Code 252 means that an attachment or other documentation is required to adjudicate a claim or service. This denial code indicates that additional information is needed in order for the insurance company to process the claim. In this article, we will explore the description of denial code 252, common reasons for its occurrence, next steps to resolve the denial, how to avoid it in the future, and provide examples of denial code 252 cases.

2. Description

Denial Code 252 is a claim adjustment reason code (CARC) that signifies the need for additional documentation or attachments to be submitted along with the claim. This code is used when the insurance company requires further information to properly adjudicate the claim or service. It is important to provide the necessary documentation to support the claim and ensure timely reimbursement.

2. Common Reasons

The most common reasons for denial code 252 are:

1. Incomplete Documentation: One of the main reasons for denial code 252 is when the submitted claim lacks the necessary attachments or supporting documentation. This could include medical records, test results, referral letters, or any other relevant information that is required for the claim to be processed.
2. Missing Information: Another common reason for denial code 252 is when the claim is missing essential information, such as patient demographics, provider information, or procedure codes. Without complete and accurate information, the insurance company cannot properly evaluate the claim.
3. Insufficient Explanation: Sometimes, the insurance company may request additional clarification or explanation for certain procedures or services. If the claim does not provide a detailed description or justification for the services rendered, it may be denied under code 252.
4. Non-Compliance with Documentation Guidelines: Insurance companies often have specific documentation requirements that must be followed. If the submitted documentation does not meet these guidelines, the claim may be denied under code 252. It is crucial to familiarize yourself with the documentation requirements of each insurance company to ensure compliance.

3. Next Steps

If you receive denial code 252, here are the next steps to resolve the issue:

1. Review the Denial Explanation: Carefully read the denial explanation provided by the insurance company. It should specify the exact documentation or attachments that are required to support the claim.
2. Gather the Necessary Documentation: Collect all the requested documentation or attachments as outlined in the denial explanation. Ensure that the information is complete, accurate, and meets the insurance company’s requirements.
3. Submit the Additional Documentation: Once you have gathered the necessary documentation, submit it to the insurance company as soon as possible. Be sure to follow their preferred method of submission, whether it is through an online portal, fax, or mail.
4. Track the Claim: Keep a record of the submission and track the progress of the claim. Follow up with the insurance company to confirm that they have received the additional documentation and that it is being reviewed.
5. Appeal if Necessary: If the claim is still denied after submitting the required documentation, you may need to file an appeal. Consult the insurance company’s appeal process and provide any additional information or arguments that support the claim.
6. Document Everything: Throughout the process, maintain detailed records of all communication, including dates, times, and the names of individuals you speak with. This documentation will be valuable if further action is required.

4. How To Avoid It

To avoid denial code 252 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 or supporting documentation are necessary for different types of claims or services.
2. Double-Check Information: Ensure that all patient demographics, provider information, and procedure codes are accurately entered into the claim. Any missing or incorrect information can lead to a denial under code 252.
3. Provide Sufficient Explanation: Include detailed descriptions and justifications for the services rendered. This will help the insurance company understand the medical necessity and appropriateness of the claim.
4. Stay Up-to-Date with Guidelines: Regularly review and stay informed about any changes or updates to the documentation guidelines of the insurance companies you work with. Compliance with these guidelines is crucial to avoid denials.

5. Example Cases

Here are two examples of denial code 252:

• Example 1: A provider submits a claim for a complex surgical procedure but fails to include the necessary operative report and supporting documentation. The claim is denied under code 252, requesting the missing attachments to properly evaluate the claim.
• Example 2: A therapist submits a claim for a series of therapy sessions but does not provide the required progress notes or treatment plans. The claim is denied under code 252, indicating that additional documentation is needed to support the medical necessity of the services rendered.

Source: Claim Adjustment Reason Codes