How To Fix Denial Code P32 | Common Reasons, Next Steps & How To Avoid It

Denial Code P32 means that a claim has been adjusted due to apportionment. Below you can find the description, common reasons for denial code P32, next steps, how to avoid it, and examples.

2. Description

Denial Code P32 is a Claim Adjustment Reason Code (CARC) and is described as ‘Payment adjusted due to Apportionment’. This indicates that the insurance company has made an adjustment to the payment for the billed service based on apportionment. Apportionment refers to the allocation of costs between multiple parties or insurance policies. In simpler terms, the claim payment has been adjusted because the responsibility for the service has been divided among different entities.

2. Common Reasons

The most common reasons for denial code P32 are:

1. Multiple Insurance Policies: Denial code P32 often occurs when a patient has multiple insurance policies that provide coverage for the same service. In these cases, the insurance companies may apportion the responsibility for payment based on the terms of the policies and the coordination of benefits rules. This can result in a partial payment or adjustment of the claim.
2. Incorrect Apportionment: Sometimes, the apportionment of costs between insurance policies may be incorrect or disputed. This can lead to denials or adjustments under code P32. It may occur due to errors in the coordination of benefits process, misinterpretation of policy terms, or lack of communication between insurance companies.
3. Missing or Incomplete Information: If the claim does not provide sufficient information about the multiple insurance policies involved or the coordination of benefits, the insurance company may deny or adjust the claim under code P32. It is important to ensure that all relevant insurance information is accurately and completely provided when submitting the claim.
4. Policy Limitations: Some insurance policies have specific limitations or exclusions that may affect the apportionment of costs. For example, certain services or conditions may not be covered by one policy but are covered by another. In such cases, the insurance company may adjust the claim under code P32 to reflect the appropriate apportionment based on the policy terms.

3. Next Steps

You can address denial code P32 as follows:

1. Review Apportionment Details: First, review the explanation of benefits (EOB) or the adjustment information provided by the insurance company. Understand how the apportionment was calculated and the specific reasons for the adjustment. This will help you determine if the apportionment was done correctly or if there are any discrepancies.
2. Verify Insurance Information: Double-check the insurance information provided on the claim. Ensure that all relevant insurance policies are accurately listed, including policy numbers, names of insurance companies, and any coordination of benefits details. If any information is missing or incorrect, update the claim accordingly.
3. Communicate with Insurance Companies: If there are any concerns or disputes regarding the apportionment, reach out to the insurance companies involved. Provide them with the necessary information and documentation to support your position. Engage in a dialogue to resolve any discrepancies or misunderstandings.
4. Appeal the Decision: If you believe that the apportionment was done incorrectly or that the adjustment under code P32 is unjustified, consider filing an appeal. Follow the insurance company’s appeal process and provide any additional supporting documentation or evidence to strengthen your case.
5. Coordinate with Patients: Keep the patients informed about the apportionment and any adjustments made to their claims. Explain the reasons behind the adjustment and how it affects their financial responsibility. This will help manage their expectations and address any questions or concerns they may have.

4. How To Avoid It

To avoid denial code P32 in the future, consider the following steps:

1. Verify Insurance Coverage: Before providing services, verify the patient’s insurance coverage and determine if they have multiple insurance policies. Obtain all relevant insurance information and ensure that it is accurately recorded in the patient’s file.
2. Understand Coordination of Benefits: Familiarize yourself with the coordination of benefits rules and guidelines. Understand how the apportionment of costs is determined and the factors that may affect it, such as policy terms and limitations.
3. Submit Complete and Accurate Claims: When submitting claims, provide all necessary information about the multiple insurance policies involved. Include policy numbers, insurance company names, and any coordination of benefits details. Ensure that the information is accurate and up to date.
4. Communicate with Insurance Companies: Maintain open lines of communication with the insurance companies. If there are any changes in the patient’s insurance coverage or if there are any concerns about the apportionment, notify the insurance companies promptly.
5. Educate Staff and Patients: Train your staff on the coordination of benefits process and the importance of accurate insurance information. Educate patients about their insurance coverage and the potential for apportionment of costs. Encourage them to provide complete and up-to-date insurance information.

5. Example Cases

Below are two examples of denial code P32:

• Example 1: A patient has two insurance policies, one through their employer and another through their spouse’s employer. The claim for a medical procedure is submitted to both insurance companies. The primary insurance company pays a portion of the claim, and the secondary insurance company adjusts the claim under code P32 to reflect their portion of the responsibility.
• Example 2: A patient has a primary insurance policy through their employer and a secondary insurance policy through a government program. The claim for a covered service is submitted to both insurance companies. The primary insurance company pays the full amount, and the secondary insurance company adjusts the claim under code P32 to indicate that they have no responsibility for the service.

Source: Claim Adjustment Reason Codes