Denial Code 264 means that there has been an adjustment for postage cost. This denial code is specific to pharmaceutical claims. In this article, we will provide a description of denial code 264, common reasons for its occurrence, next steps to resolve it, tips on how to avoid it in the future, and examples of denial code 264 cases.
2. Description
Denial Code 264 is an adjustment for postage cost. It is a specific denial code that is applicable only to pharmaceutical claims. This code indicates that the insurance company will not reimburse the provider for the cost of postage associated with the pharmaceutical claim. The denial is based on the policy that the insurance company does not cover postage expenses for pharmaceutical claims.
2. Common Reasons
The most common reasons for denial code 264 are:
- Non-Coverage of Postage: Insurance policies may explicitly state that they do not cover postage expenses for pharmaceutical claims. This can result in denial code 264 if the provider submits a claim seeking reimbursement for postage costs.
- Incorrect Billing: Denial code 264 can occur if the provider mistakenly includes postage costs in the claim submission. It is important for providers to accurately separate the cost of the pharmaceutical product from any associated postage expenses.
- Failure to Verify Coverage: Providers may overlook the insurance policy’s exclusion of postage coverage for pharmaceutical claims. This can lead to the submission of claims that include postage costs, resulting in denial code 264.
3. Next Steps
If you encounter denial code 264, follow these next steps to resolve it:
- Review the Claim: Carefully review the claim to ensure that it does not include any postage costs. If postage costs were mistakenly included, remove them from the claim.
- Verify Insurance Policy: Confirm the insurance policy’s coverage details regarding postage expenses for pharmaceutical claims. If the policy explicitly excludes coverage for postage, accept the denial and adjust the claim accordingly.
- Appeal if Applicable: If you believe that the denial is in error and the insurance policy does cover postage expenses, gather supporting documentation and submit an appeal to the insurance company. Provide evidence of the policy’s coverage for postage costs and explain why the denial is incorrect.
- Adjust Billing Practices: Going forward, ensure that postage costs are not included in pharmaceutical claim submissions. Train your billing staff to accurately separate the cost of the pharmaceutical product from any associated postage expenses.
4. How To Avoid It
To avoid denial code 264 in the future, follow these tips:
- Review Insurance Policies: Familiarize yourself with the insurance policies of the various payers you work with. Pay attention to any exclusions or limitations regarding postage expenses for pharmaceutical claims.
- Separate Postage Costs: When preparing pharmaceutical claim submissions, ensure that postage costs are clearly separated from the cost of the pharmaceutical product. This will help prevent the inclusion of postage expenses in the claim.
- Train Billing Staff: Educate your billing staff about denial code 264 and the importance of accurately separating postage costs from pharmaceutical claim submissions. Provide training on how to review claims for any potential inclusion of postage expenses.
5. Example Cases
Here are two examples of denial code 264:
- Example 1: A pharmacy submits a claim for a prescription medication, including the cost of postage for mailing the medication to the patient. The claim is denied under code 264 because the insurance policy explicitly excludes coverage for postage expenses.
- Example 2: A provider mistakenly includes the cost of postage in a pharmaceutical claim submission. The claim is denied under code 264, and upon review, the provider realizes the error and removes the postage costs from the claim before resubmitting it.
