How To Fix Denial Code P29 | Common Reasons, Next Steps & How To Avoid It

Denial Code P29 means that there has been a jurisdictional fee schedule adjustment for liability benefits. This denial code is typically used in Property and Casualty Auto claims. In this article, we will explore the description of denial code P29, common reasons for its occurrence, next steps to resolve it, how to avoid it in the future, and provide examples of cases where this denial code may be encountered.

2. Description

Denial Code P29 is a specific Claim Adjustment Reason Code (CARC) that indicates a jurisdictional fee schedule adjustment for liability benefits. This means that the payment for the claim has been adjusted based on the fee schedule set by the jurisdiction in which the claim is being processed. The payer will provide further information in the 835 Class of Contract Code Identification Segment or the 835 Healthcare Policy Identification Segment, depending on whether the adjustment is at the claim level or line level, respectively. Denial code P29 is typically applicable to Property and Casualty Auto claims.

2. Common Reasons

The most common reasons for denial code P29 are:

1. Jurisdictional Fee Schedule Adjustment: Denial code P29 is triggered when the payment for the claim is adjusted based on the fee schedule set by the jurisdiction. This adjustment may be due to specific regulations or requirements that apply to the jurisdiction in which the claim is being processed.
2. Non-Compliance with Jurisdictional Regulations: If the claim does not meet the specific regulations or requirements set by the jurisdiction, it may result in a denial with code P29. This could include issues such as incomplete documentation, missing information, or failure to meet specific criteria outlined by the jurisdiction.
3. Incorrect Billing or Coding: Inaccurate billing or coding practices can also lead to denial code P29. If the billed services or procedures do not align with the fee schedule or regulations set by the jurisdiction, the claim may be denied with this code.
4. Missing or Incomplete Information: Claims that lack necessary information or have incomplete documentation may be denied with code P29. It is essential to ensure that all required information is included in the claim submission to avoid this denial code.

3. Next Steps

To resolve denial code P29, the following steps can be taken:

1. Review the Explanation of Benefits (EOB): Carefully review the EOB provided by the payer to understand the specific details of the jurisdictional fee schedule adjustment. This will help in identifying the reason for the denial and the necessary actions to be taken.
2. Verify Compliance with Jurisdictional Regulations: Ensure that the claim meets all the regulations and requirements set by the jurisdiction. Review the documentation, coding, and billing practices to identify any discrepancies or non-compliance issues that may have led to the denial.
3. Address Missing or Incomplete Information: If the denial was due to missing or incomplete information, gather the necessary documentation and ensure that all required details are included in the claim resubmission. This may involve reaching out to the provider or other relevant parties to obtain the required information.
4. Correct Billing or Coding Errors: If the denial was a result of incorrect billing or coding, make the necessary corrections to align with the fee schedule and regulations set by the jurisdiction. This may involve consulting with coding experts or seeking guidance from the payer to ensure accurate billing practices.
5. Resubmit the Claim: Once all necessary actions have been taken to address the denial reason, resubmit the claim with the appropriate adjustments and documentation. Include any additional information or explanations that may support the claim and help in overturning the denial.
6. Follow Up with the Payer: After resubmitting the claim, follow up with the payer to ensure that it is being processed correctly. Communicate any additional information or documentation that may be required to resolve the denial and expedite the claim processing.

4. How To Avoid It

To avoid denial code P29 in the future, consider the following strategies:

1. Stay Updated with Jurisdictional Regulations: Stay informed about the specific regulations and requirements set by the jurisdiction in which the claim is being processed. Regularly review any updates or changes to ensure compliance and accurate billing practices.
2. Ensure Accurate Billing and Coding: Implement robust billing and coding practices to ensure accurate submission of claims. Regularly train and educate staff members on the latest coding guidelines and fee schedules to minimize errors that could lead to denials.
3. Thoroughly Review Claims Before Submission: Before submitting a claim, conduct a thorough review to ensure that all required information is included and accurate. Double-check the coding, documentation, and any supporting documentation to minimize the risk of denials due to missing or incomplete information.
4. Communicate with Payers: Establish open lines of communication with payers to clarify any questions or concerns regarding jurisdictional fee schedules. Seek guidance or clarification when needed to ensure accurate billing and compliance with regulations.

5. Example Cases

Here are two examples of denial code P29:

• Example 1: A healthcare provider submits a claim for an auto accident injury treatment. However, the claim is denied with code P29 because the billed amount exceeds the fee schedule set by the jurisdiction for auto accident-related services.
• Example 2: A provider submits a claim for a property damage assessment following a natural disaster. The claim is denied with code P29 because the documentation submitted does not meet the specific requirements outlined by the jurisdiction for property damage claims.

Source: Claim Adjustment Reason Codes