Denial Code 32 means that our records indicate the patient is not an eligible dependent. Below you can find the description, common reasons for denial code 32, next steps, how to avoid it, and examples.
2. Description
Denial Code 32 is a Claim Adjustment Reason Code (CARC) that indicates our records show the patient is not an eligible dependent. This means that the patient does not meet the criteria to be considered a dependent under the insurance policy. As a result, the claim is denied as the services provided are not covered for this individual.
2. Common Reasons
The most common reasons for denial code 32 are:
- Ineligible Dependent Status: Denial code 32 is often triggered when the patient is not listed as a dependent on the insurance policy. This can occur when the patient is no longer eligible for dependent coverage due to age, marital status, or other factors outlined in the policy.
- Missing or Incorrect Dependent Information: Denial code 32 can also occur if there are errors or omissions in the dependent information provided on the claim. This could include incorrect birth dates, social security numbers, or other identifying details that are necessary to establish dependent status.
- Lack of Supporting Documentation: In some cases, denial code 32 may be issued if the necessary documentation to prove dependent status is not provided with the claim. This could include marriage certificates, birth certificates, or other legal documents that establish the relationship between the patient and the policyholder.
- Policy Limitations: Certain insurance policies may have specific limitations on dependent coverage, such as age restrictions or requirements for full-time student status. If the patient does not meet these criteria, denial code 32 may be applied.
- Termination of Coverage: Denial code 32 can also occur if the patient’s coverage has been terminated or suspended for any reason. This could be due to non-payment of premiums, policy cancellations, or other factors that result in the patient no longer being eligible for dependent coverage.
3. Next Steps
You can address denial code 32 by taking the following steps:
- Review Policy and Documentation: Start by reviewing the insurance policy and any supporting documentation to ensure that the patient meets the criteria for dependent coverage. Check for any limitations or requirements that may impact the patient’s eligibility.
- Verify Dependent Information: Double-check the dependent information provided on the claim to ensure its accuracy. Confirm that all necessary details, such as birth dates and social security numbers, are correct and match the information on file with the insurance company.
- Obtain Supporting Documentation: If the patient’s dependent status is in question, gather the necessary supporting documentation to establish their eligibility. This may include marriage certificates, birth certificates, or other legal documents that prove the relationship between the patient and the policyholder.
- Appeal or Correct the Claim: If you believe the denial was issued in error or have obtained the necessary documentation to prove dependent status, you can appeal the denial or correct the claim. Follow the insurance company’s specific procedures for appeals or claim corrections, providing any additional documentation or information as required.
- Communicate with the Insurance Company: If there are any discrepancies or questions regarding the patient’s dependent status, reach out to the insurance company directly. Discuss the situation with their provider support team and provide any necessary documentation or information to resolve the issue.
- Update Patient Information: If the denial was due to missing or incorrect dependent information, update the patient’s records to ensure accurate and up-to-date information is on file for future claims.
4. How To Avoid It
To avoid denial code 32 in the future, consider the following steps:
- Verify Dependent Eligibility: Before providing services, verify the patient’s dependent status with the insurance company. Ensure that they meet the criteria for dependent coverage, including any age restrictions, student status requirements, or other limitations outlined in the policy.
- Collect Accurate Dependent Information: When gathering patient information, pay close attention to the dependent details. Collect accurate birth dates, social security numbers, and other identifying information to establish the patient’s dependent status correctly.
- Keep Documentation Up to Date: Maintain up-to-date documentation for each patient’s dependent status. Regularly review and update any necessary supporting documents, such as marriage certificates or birth certificates, to ensure they are readily available if needed.
- Stay Informed of Policy Changes: Stay informed about any changes or updates to the insurance policy regarding dependent coverage. This can help you proactively address any potential issues and ensure that claims are submitted correctly.
- Communicate with Patients: Educate patients about the requirements and limitations of their dependent coverage. Clearly communicate any changes or updates to the policy that may impact their eligibility as dependents.
5. Example Cases
Below are two examples of denial code 32:
- Example 1: A patient who recently turned 26 years old and is no longer eligible for dependent coverage under their parent’s insurance policy submits a claim for medical services. The claim is denied under denial code 32, indicating that the patient is not an eligible dependent.
- Example 2: A claim is submitted for a patient who is listed as a dependent on the insurance policy, but the birth date provided on the claim does not match the information on file. The claim is denied under denial code 32 due to the discrepancy in dependent information.
