Denial Code B20 means that the procedure or service billed was partially or fully furnished by another provider. Below you can find the description, common reasons for denial code B20, next steps, how to avoid it, and examples.
2. Description
Denial Code B20 is a Claim Adjustment Reason Code (CARC) and is described as ‘Procedure/Service Furnished by Another Provider’. This code indicates that the claim has been denied because the procedure or service billed was already provided by another healthcare provider. In simpler terms, the insurance company will not make payment for the duplicated or overlapping services.
2. Common Reasons
The most common reasons for denial code B20 are:
- Duplicated Services: Denial code B20 is often triggered when a provider bills for a procedure or service that has already been performed by another healthcare professional. This can occur due to miscommunication, lack of coordination, or failure to review the patient’s medical records before submitting the claim.
- Overlapping Services: In some cases, multiple providers may perform similar procedures or services within a short timeframe. If the services are deemed overlapping or redundant, the insurance company may deny the claim under code B20.
- Incorrect Billing Information: Errors in the billing process, such as incorrect procedure codes or provider identification, can result in denials under code B20. These mistakes can lead to the perception that the same service was furnished by different providers.
- Lack of Documentation: Insufficient or incomplete documentation can also lead to denials under code B20. If the claim lacks proper evidence to support the necessity of the procedure or service, the insurance company may deny the claim as a result.
- Out-of-Network Providers: Denial code B20 can occur when a patient receives services from an out-of-network provider. If the insurance plan does not cover out-of-network services, the claim may be denied under this code.
3. Next Steps
You can fix denial code B20 as follows:
- Review Medical Records: Before submitting a claim, thoroughly review the patient’s medical records to ensure that the procedure or service has not already been furnished by another provider. This step helps identify any potential duplications or overlaps.
- Coordinate with Other Providers: If you discover that another provider has already performed the same procedure or service, reach out to them to discuss the situation. Determine if the claim should be adjusted or if there was an error in the billing process.
- Provide Supporting Documentation: If the claim was denied due to lack of documentation, gather all necessary evidence to support the medical necessity of the procedure or service. This may include medical records, test results, or physician notes. Resubmit the claim with the additional documentation to challenge the denial.
- Verify Network Coverage: If the denial was due to the patient receiving services from an out-of-network provider, confirm the patient’s insurance coverage and network status. Educate the patient about their network limitations and discuss alternative options if necessary.
- Appeal the Denial: If you believe the denial was in error or unjustified, file an appeal with the insurance company. Provide a detailed explanation of why the claim should be reconsidered, including any supporting documentation or communication with other providers.
4. How To Avoid It
You can prevent denial code B20 in the future as follows:
- Enhance Communication: Improve communication and coordination among healthcare providers to ensure that duplicate or overlapping services are avoided. Implement systems or protocols to share patient information and treatment plans to minimize the risk of billing for services already furnished.
- Double-Check Billing Information: Take extra care when entering procedure codes, provider identification, and other billing details. Regularly review and reconcile claims to identify any potential errors or discrepancies that could lead to denials under code B20.
- Document Medical Necessity: Thoroughly document the medical necessity of each procedure or service provided. Include detailed notes, test results, and any other relevant information to support the claim and minimize the risk of denials due to lack of documentation.
- Verify Network Participation: Before providing services, verify the patient’s insurance coverage and network participation. Educate patients about their network limitations and potential out-of-pocket expenses if they choose to receive services from out-of-network providers.
5. Example Cases
Below are two examples of denial code B20:
- Example 1: A patient undergoes a diagnostic imaging procedure at one healthcare facility but later seeks the same procedure at a different facility without informing either provider. When the claim is submitted for the second procedure, it is denied under code B20 as the service was already furnished by another provider.
- Example 2: A patient receives physical therapy from two different providers within a short timeframe. The insurance company denies the claim for the second provider’s services under code B20, considering them overlapping and unnecessary.
