How To Fix Denial Code 293 | Common Reasons, Next Steps & How To Avoid It

Denial Code 293 means that payment has been made to the employer. Below you can find the description, common reasons for denial code 293, next steps, how to avoid it, and examples.

2. Description

Denial Code 293 is a Claim Adjustment Reason Code (CARC) and is described as ‘Payment made to employer’. This code indicates that the payment for the claim has been made directly to the employer instead of the healthcare provider. It typically occurs when the insurance company determines that the employer is responsible for the payment of the claim, rather than the patient or the healthcare provider.

2. Common Reasons

The most common reasons for denial code 293 are:

1. Employer Responsibility: Denial code 293 is often triggered when the insurance company determines that the employer is responsible for the payment of the claim. This can happen in cases where the healthcare services are related to work-related injuries or illnesses, or when the employer has a specific agreement with the insurance company to handle certain types of claims.
2. Incorrect Billing Information: Denial code 293 can also occur due to errors in the billing information submitted by the healthcare provider. If the provider mistakenly bills the insurance company instead of the employer, or if the billing information does not clearly indicate that the employer should be responsible for the payment, the claim may be denied under code 293.
3. Lack of Coordination: In some cases, denial code 293 may be the result of a lack of coordination between the healthcare provider, the insurance company, and the employer. If there is confusion or miscommunication regarding who should be responsible for the payment, the claim may be denied under this code.

3. Next Steps

If you receive denial code 293, you can take the following steps to address it:

1. Review the Claim: Carefully review the claim to ensure that the billing information accurately reflects the responsibility for payment. If there are any errors or inconsistencies, correct them and resubmit the claim.
2. Contact the Insurance Company: If you believe that the denial under code 293 is incorrect, contact the insurance company to discuss the situation. Provide any necessary documentation or information to support your claim that the payment should be made to the healthcare provider rather than the employer.
3. Communicate with the Employer: If the denial is due to the employer’s responsibility for payment, reach out to the employer to discuss the situation. Clarify any misunderstandings or address any issues that may have led to the denial. Work together to find a resolution that is acceptable to all parties involved.
4. Appeal the Denial: If you believe that the denial under code 293 is unjustified, you have the option to appeal the decision. Follow the insurance company’s appeals process and provide any necessary documentation or information to support your case.

4. How To Avoid It

To avoid denial code 293 in the future, consider the following steps:

1. Verify Employer Responsibility: Before submitting a claim, verify whether the employer is responsible for the payment. If the services are related to work-related injuries or illnesses, or if there is a specific agreement in place, ensure that the billing information clearly indicates that the employer should be billed.
2. Ensure Accurate Billing Information: Double-check the billing information to ensure that it accurately reflects the responsibility for payment. Clearly indicate if the employer should be responsible for the payment and provide any necessary documentation or information to support this.
3. Coordinate with All Parties Involved: Maintain open lines of communication with the healthcare provider, the insurance company, and the employer. Ensure that everyone is aware of their respective responsibilities and that there is a clear understanding of how claims should be handled.

5. Example Cases

Below are two examples of denial code 293:

• Example 1: A patient seeks medical treatment for a work-related injury. The healthcare provider submits a claim to the insurance company, but it is denied under code 293 because the employer is responsible for the payment of work-related injury claims.
• Example 2: A healthcare provider mistakenly bills the insurance company for services that should be the responsibility of the employer. The claim is denied under code 293, indicating that the payment should be made to the employer.

Source: Claim Adjustment Reason Codes