How To Fix Denial Code P19 | Common Reasons, Next Steps & How To Avoid It
Denial Code P19 means that a claim has been denied because the procedure being billed has a relative value of zero in the jurisdiction fee schedule, resulting in no payment being due. This denial code is specific to Property and Casualty insurance claims. In this article, we will explore the description of denial code P19, 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 P19 is a claim adjustment reason code (CARC) that indicates the procedure being billed has a relative value of zero in the jurisdiction fee schedule. This means that the insurance company will not make any payment for the procedure because it is deemed to have no value according to the fee schedule. Denial code P19 is specific to Property and Casualty insurance claims and is effective from November 1, 2013. It replaces the previously deactivated code W8.
2. Common Reasons
The most common reasons for denial code P19 are:
- Procedure Value: Denial code P19 occurs when the procedure being billed is assigned a relative value of zero in the jurisdiction fee schedule. This could be due to various reasons, such as the procedure being considered unnecessary or not covered under the insurance policy.
- Property and Casualty Insurance: Denial code P19 is specific to Property and Casualty insurance claims. If the claim is submitted under a different type of insurance, such as health insurance, it may result in a denial under a different code.
3. Next Steps
To resolve denial code P19, the following steps can be taken:
- Review Fee Schedule: Verify the jurisdiction fee schedule to determine if the procedure being billed is indeed assigned a relative value of zero. This will help confirm if the denial is valid or if there has been an error in the fee schedule.
- Appeal or Resubmit: If it is determined that the denial is incorrect, gather supporting documentation and submit an appeal to the insurance company. Alternatively, if the procedure is not covered under the insurance policy, consider resubmitting the claim with a different procedure code that is covered.
- Seek Clarification: Contact the insurance company’s provider support to seek clarification on the specific reason for the denial. This can help in understanding the rationale behind the denial and provide guidance on how to proceed.
4. How To Avoid It
To avoid denial code P19 in the future, consider the following measures:
- Verify Coverage: Before performing any procedures, verify the coverage details of the insurance policy. Ensure that the procedure being performed is covered and has a relative value assigned in the jurisdiction fee schedule.
- Communicate with the Insurance Company: If there is any uncertainty regarding the coverage or relative value of a procedure, reach out to the insurance company for clarification. This can help avoid submitting claims for procedures that may result in denial under code P19.
5. Example Cases
Below are two examples of denial code P19:
- Example 1: A healthcare provider submits a claim for a procedure that is not covered under the patient’s Property and Casualty insurance policy. The claim is denied under code P19, indicating that no payment is due as the procedure has a relative value of zero in the jurisdiction fee schedule.
- Example 2: A provider mistakenly bills a procedure under the wrong insurance type, such as health insurance instead of Property and Casualty insurance. The claim is denied under a different denial code, as P19 is specific to Property and Casualty insurance claims.
Source: Claim Adjustment Reason Codes
