How To Fix Denial Code P2 | Common Reasons, Next Steps & How To Avoid It

Denial Code P2 means that the claim has been denied because it is not a work-related injury or illness and therefore not the liability of the workers’ compensation carrier. In this article, we will provide a description of denial code P2, common reasons for its occurrence, next steps to resolve the denial, tips on how to avoid it in the future, and examples of denial code P2 cases.

2. Description

Denial Code P2 is specific to workers’ compensation claims and indicates that the claim has been denied because it does not meet the criteria of being a work-related injury or illness. This means that the workers’ compensation carrier is not responsible for covering the costs associated with the claim. The payer must provide additional information in the 835 Insurance Policy Number Segment or the 835 Healthcare Policy Identification Segment to clarify the jurisdictional regulations and guidelines for workers’ compensation claims.

2. Common Reasons

The most common reasons for denial code P2 are:

1. Non-Work-Related Injury or Illness: Denial code P2 is triggered when the claim submitted is not related to a work-related injury or illness. This could occur if the injury or illness was sustained outside of the workplace or if it is not directly related to the individual’s job duties.
2. Lack of Supporting Documentation: Insufficient or inadequate documentation to prove that the injury or illness is work-related can lead to denial code P2. It is essential to provide detailed medical records, incident reports, and any other relevant evidence to support the claim.
3. Incomplete or Inaccurate Information: Errors or omissions in the claim submission, such as incorrect patient information, service codes, or dates of service, can result in denial code P2. It is crucial to double-check all information before submitting the claim to ensure accuracy.
4. Failure to Meet Jurisdictional Regulations: Each jurisdiction may have specific regulations and guidelines regarding what qualifies as a work-related injury or illness. If the claim does not meet these requirements, it may be denied under code P2. Providers should familiarize themselves with the jurisdictional regulations to avoid such denials.

3. Next Steps

To resolve denial code P2, the following steps can be taken:

1. Review Claim Documentation: Carefully review the claim documentation to ensure that it clearly demonstrates that the injury or illness is work-related. If any supporting documentation is missing or incomplete, gather the necessary evidence to strengthen the claim.
2. Consult Jurisdictional Regulations: Refer to the jurisdictional regulations and guidelines for workers’ compensation claims to determine if the claim meets the criteria. If there are any doubts or uncertainties, seek clarification from the appropriate authorities or legal counsel.
3. Appeal the Denial: If the denial appears to be incorrect or unjustified based on the jurisdictional regulations and the supporting documentation, file an appeal with the workers’ compensation carrier. Provide a detailed explanation and submit all relevant evidence to support the appeal.
4. Collaborate with the Employer: Work closely with the employer to gather any additional information or documentation that may be required to support the claim. The employer’s cooperation and involvement can significantly strengthen the case.
5. Seek Legal Assistance: If the denial persists or if there are complex legal issues involved, it may be necessary to seek legal assistance from an attorney specializing in workers’ compensation claims. They can provide guidance and represent the provider’s interests throughout the appeals process.

4. How To Avoid It

To avoid denial code P2 in the future, consider the following tips:

1. Educate Employees: Ensure that employees are aware of what qualifies as a work-related injury or illness. Provide training and clear guidelines to help them understand when to seek workers’ compensation benefits.
2. Thorough Documentation: Encourage employees to report any work-related injuries or illnesses promptly. Maintain detailed incident reports and medical records to support future claims.
3. Compliance with Regulations: Stay updated on the jurisdictional regulations and guidelines for workers’ compensation claims. Ensure that all claims meet the specific requirements of the jurisdiction.
4. Accurate Claim Submission: Double-check all information before submitting a claim to avoid errors or omissions. Verify patient information, service codes, and dates of service for accuracy.
5. Collaboration with Employers: Foster open communication and collaboration with employers to ensure that all necessary information and documentation are provided to support the claim.

5. Example Cases

Here are two examples of denial code P2:

• Example 1: A healthcare provider submits a claim for an individual who sustained an injury while participating in a recreational activity outside of work. Since the injury is not work-related, the claim is denied under code P2.
• Example 2: A provider submits a claim for an employee who experienced a back injury while lifting heavy objects at work. The claim includes detailed incident reports, medical records, and witness statements, clearly demonstrating that the injury is work-related. The claim is approved, and denial code P2 is not triggered.

Source: Claim Adjustment Reason Codes