CO146 denial code description and corrective action

• This denial occurs when the insurance considers the diagnosis code billed was invalid for date of service (DOS) reported.

Actions

• First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.

• The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.

• Call the insurance company, if claims in the member’s history with the same coding have been paid, and ask the representative to reprocess the claim. Be sure to note the claim number, rep name and call reference number, and then follow up on the claim after the provided TAT.

• Confirm with the insurance representative which diagnosis is invalid, especially if multiple diagnoses were used.

• Consult coding specialists to determine whether the diagnosis code is appropriate or not.

• If the coding team confirms that the diagnosis is appropriate with DOS then we proceed with submitting an appeal.

• If we determine that the denial is accurate, then we submit a corrected claim with the required modifications (correct diagnosis).

• Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.

• For submitting an appeal/corrected claim, must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the appeal/corrected claim even after the timely filing limit has passed, so we should proceed according to their instructions.

Description