How To Fix Denial Code 299 | Common Reasons, Next Steps & How To Avoid It

Denial Code 299 means that the billing provider is not eligible to receive payment for the service billed. This denial code indicates that the insurance company has determined that the provider does not meet the necessary requirements to receive reimbursement for the service rendered. In this article, we will explore the description of denial code 299, 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 299 is a specific Claim Adjustment Reason Code (CARC) that signifies that the billing provider is not eligible to receive payment for the service billed. This denial code is typically issued when the insurance company determines that the provider does not meet the necessary criteria or qualifications to receive reimbursement for the service rendered. It is important to note that denial code 299 does not necessarily imply that the service itself was not medically necessary or appropriate, but rather that the provider is not authorized to receive payment for it.

2. Common Reasons

There are several common reasons why denial code 299 may occur:

1. Lack of Credentialing: One of the primary reasons for denial code 299 is the lack of proper credentialing. Insurance companies require providers to go through a credentialing process to ensure that they meet specific qualifications and standards. If a provider has not completed the necessary credentialing or if their credentials have expired, the insurance company may deny payment for the services rendered.
2. Out-of-Network Provider: Denial code 299 may also occur when a provider is considered out-of-network for a particular insurance plan. Insurance companies often have networks of preferred providers with whom they have negotiated reimbursement rates. If a provider is not part of the network for a specific insurance plan, the insurance company may deny payment for the services rendered.
3. Lapsed or Inactive Provider Status: Providers must maintain an active status with the relevant licensing and regulatory bodies. If a provider’s license or certification has lapsed or if their status is inactive, the insurance company may deny payment for the services rendered.
4. Non-Compliance with Documentation Requirements: Insurance companies have specific documentation requirements that providers must adhere to when submitting claims. If a provider fails to meet these requirements or if the documentation is incomplete or inaccurate, the insurance company may deny payment for the services rendered.
5. Exclusion from Insurance Plans: Some insurance plans may have specific exclusions for certain providers or services. If a provider is excluded from a particular insurance plan or if the service rendered is excluded from coverage, the insurance company may deny payment for the services rendered.

3. Next Steps

If you receive denial code 299, it is important to take the following steps to resolve the denial:

1. Review the Denial Explanation: Carefully review the explanation provided by the insurance company for the denial. Understand the specific reason why the provider is not eligible to receive payment for the service billed.
2. Contact the Insurance Company: Reach out to the insurance company’s provider support or claims department to seek clarification on the denial. Discuss the specific circumstances surrounding the denial and inquire about any additional information or documentation that may be required to resolve the issue.
3. Address the Issue: Take the necessary steps to address the issue that led to the denial. This may involve completing the credentialing process, updating licensing or certification status, or ensuring compliance with documentation requirements.
4. Resubmit the Claim: Once the issue has been addressed, resubmit the claim with any additional information or documentation requested by the insurance company. Ensure that all necessary information is accurate and complete to increase the chances of a successful reimbursement.
5. Follow Up: Monitor the status of the resubmitted claim and follow up with the insurance company if necessary. Keep track of any communication or correspondence related to the denial and subsequent resolution.

4. How To Avoid It

To avoid denial code 299 in the future, providers can take the following steps:

1. Complete Credentialing Process: Ensure that all necessary credentialing processes are completed and kept up to date. Regularly review and renew credentials as required by the insurance companies.
2. Verify Network Participation: Confirm network participation for each insurance plan before providing services to patients. If a provider is not part of a specific network, consider alternative options or discuss out-of-network arrangements with patients.
3. Maintain Active Provider Status: Stay informed about licensing and certification requirements and ensure that all necessary licenses and certifications are renewed and maintained in an active status.
4. Adhere to Documentation Requirements: Familiarize yourself with the documentation requirements of each insurance plan and ensure that all necessary documentation is accurate, complete, and submitted in a timely manner.
5. Stay Informed about Plan Exclusions: Regularly review the coverage details and exclusions of each insurance plan to ensure that services provided are eligible for reimbursement.

5. Example Cases

Here are two examples of denial code 299:

• Example 1: A provider submits a claim for a service but fails to complete the necessary credentialing process with the insurance company. The claim is denied under denial code 299, indicating that the provider is not eligible to receive payment for the service billed.
• Example 2: A provider renders a service to a patient who is covered by an insurance plan, but the provider is considered out-of-network for that particular plan. The claim is denied under denial code 299, as the provider is not eligible to receive payment for the service rendered.

Denial code 299 can be challenging to navigate, but by understanding the reasons for its occurrence, taking appropriate steps to resolve the denial, and implementing preventive measures, providers can minimize the impact of this denial code on their reimbursement. It is crucial to maintain open communication with insurance companies, stay informed about plan requirements, and ensure compliance with all necessary regulations and documentation.

Source: Claim Adjustment Reason Codes