Denial Code 267 means that a claim or service spans multiple months and requires additional information to be provided. This denial code is specific to situations where the claim or service extends beyond a single billing period and requires clarification or explanation. In this article, we will explore the description of denial code 267, common reasons for its occurrence, next steps to resolve the denial, how to avoid it in the future, and provide examples to illustrate its application.
2. Description
Denial Code 267 is a claim adjustment reason code (CARC) that indicates a claim or service spans multiple months and requires additional information to be provided. This denial code is used when the billing period for a claim or service extends beyond a single month and necessitates further clarification or explanation. It is important to address this denial code promptly to ensure timely reimbursement and avoid any delays in payment.
2. Common Reasons
The most common reasons for denial code 267 are:
- Missing or Incomplete Documentation: Denial code 267 may occur if the necessary documentation or information to support the claim or service spanning multiple months is missing or incomplete. This could include details such as the start and end dates of the service, the reason for the extended duration, or any other relevant information that helps justify the need for the extended billing period.
- Lack of Explanation: If the claim or service spans multiple months but there is no clear explanation provided as to why this is necessary, denial code 267 may be issued. It is essential to provide a detailed explanation in the claim or accompanying documentation to ensure the payer understands the reasons for the extended billing period.
- Incorrect Billing Period: Denial code 267 can also occur if the billing period indicated on the claim does not align with the actual duration of the service. It is crucial to accurately reflect the start and end dates of the service to avoid any confusion or discrepancies that may lead to a denial.
- Insufficient Supporting Documentation: In some cases, the supporting documentation provided with the claim may not sufficiently demonstrate the need for the extended billing period. This could include medical records, progress notes, or any other relevant documentation that helps substantiate the necessity of the service spanning multiple months.
3. Next Steps
To resolve denial code 267, the following steps can be taken:
- Review the Denial Explanation: Carefully review the denial explanation provided by the payer to understand the specific reason for denial code 267. This will help identify the exact information or documentation that needs to be provided to address the denial.
- Gather Additional Information: Collect any additional information or documentation that is required to support the claim or service spanning multiple months. This may include detailed progress notes, medical records, or any other relevant documentation that helps justify the extended billing period.
- Submit a Reconsideration or Appeal: Prepare a reconsideration or appeal letter that includes the necessary information and documentation to address the denial. Clearly explain the reasons for the extended billing period and provide any supporting evidence that helps substantiate the need for the service spanning multiple months.
- Follow Up with the Payer: After submitting the reconsideration or appeal, follow up with the payer to ensure that the necessary information has been received and is being reviewed. Maintain open communication with the payer to address any additional questions or concerns they may have regarding the claim or service.
- Document the Process: Keep a record of all communication, documentation, and steps taken to resolve the denial. This will help track the progress of the resolution and serve as a reference in case of any further inquiries or appeals.
4. How To Avoid It
To avoid denial code 267 in the future, consider the following strategies:
- Accurate Documentation: Ensure that all documentation accurately reflects the start and end dates of the service. Clearly explain the reasons for the extended billing period and provide any necessary supporting documentation to justify the need for the service spanning multiple months.
- Thorough Explanation: Include a detailed explanation in the claim or accompanying documentation that clearly outlines why the service spans multiple months. This will help the payer understand the necessity of the extended billing period and reduce the likelihood of a denial.
- Review Billing Periods: Double-check the billing periods indicated on the claim to ensure they align with the actual duration of the service. Avoid any discrepancies or inconsistencies that may lead to confusion or denials.
- Complete Documentation: Ensure that all necessary supporting documentation is included with the claim. This may include medical records, progress notes, or any other relevant documentation that helps substantiate the need for the service spanning multiple months.
5. Example Cases
Here are two examples of denial code 267:
- Example 1: A patient undergoes a complex surgical procedure that requires an extended recovery period spanning multiple months. The claim submitted for reimbursement does not include a detailed explanation or supporting documentation to justify the extended billing period, resulting in denial code 267.
- Example 2: A patient receives ongoing physical therapy sessions for a chronic condition that requires continuous treatment over several months. The claim submitted for reimbursement accurately reflects the start and end dates of the service, includes a thorough explanation, and provides supporting documentation to justify the extended billing period, resulting in successful reimbursement.
