Denial code 170, which signifies a claim rejection due to the type of provider rendering or billing the service, is a common issue that can disrupt healthcare practices’ revenue cycles. To minimize losses, practice managers and healthcare providers must recognize the root causes of these denials and adopt proactive strategies to resolve them.
Common Causes for Denial Code 170
- Provider Credentialing Issues:
Claims are often denied when the provider’s credentials do not match the service billed. Ensure all providers maintain up-to-date credentials and that they align with the services they perform. - Service Coverage Restrictions:
Some services are only covered when performed by specific provider types, such as physicians or specialists. Always verify the payer’s coverage guidelines to avoid conflicts. - Provider Type Limitations:
Certain providers, such as nurse practitioners or assistants, may face restrictions when billing for specific services. Confirm the match between the service and the provider’s specialty. - Payer-Specific Requirements:
Insurance payers may have unique policies regarding which provider types can perform or bill for certain services. Regularly review payer policies to stay compliant. - Incomplete Documentation:
Missing referral letters, incomplete notes, or insufficient medical documentation can lead to denial. Thoroughly document all services provided. - Coding and Billing Errors:
Incorrect codes or mismatches between services and provider types can result in rejections. Regular coding reviews help prevent these mistakes. - Authorization Issues:
If the service requires prior authorization, ensure approval is secured before proceeding with treatment to avoid claims being denied. - Service Limits:
Some procedures have specific frequency or coverage limits. Exceeding these limits may result in the payer denying the claim.
Solutions to Resolve Denial Code 170
- Credential Verification:
Regularly audit provider credentials to confirm they are current and meet service requirements. - Medical Record Reviews:
Conduct routine documentation reviews to ensure compliance and completeness. - Coding and Billing Audits:
Perform audits to identify and correct any coding or billing inconsistencies. - Effective Payer Communication:
Stay updated with payer guidelines through ongoing communication to understand changing policies. - Staff Training Programs:
Train your billing and coding team regularly on the latest payer policies and requirements to enhance accuracy. - Technology Integration:
Use revenue cycle management (RCM) software to automate processes, track claims, and prevent errors.
Why Partnering with Claims Med Can Help
Managing complex claim denials, such as denial code 170, requires expertise and careful attention to detail. At Claims Med, we specialize in denial management solutions that empower practice managers, healthcare providers, and owners to optimize their revenue cycles.
Get in touch with Claims Med today to learn how our expert services can help you reduce denials, improve cash flow, and boost your bottom line.