Mastering Denial Code 246: Solutions for Healthcare Providers

Denial code 246 is a non-payable code that indicates a claim has been halted before adjudication and returned unpaid. This issue is prevalent among healthcare providers, and grasping its causes and solutions can significantly enhance your practice’s revenue cycle.

Common Reasons for Denial Code 246

1. Incorrect Code Assignment: Misclassifying a payable service or procedure as non-payable is a frequent error.
2. Lack of Medical Necessity: Claims may be denied if the service or procedure does not meet medical necessity criteria.
3. Insufficient Documentation: Incomplete medical records can lead to denials, as they may not sufficiently support the services rendered.
4. Policy Exclusions: Certain services may be excluded from coverage based on payer policies.

Strategies to Prevent and Resolve Denial Code 246

1. Thorough Claim Review: Regularly analyze Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to spot claims with denial code 246. Cross-reference these with the original claim and specific reporting requirements.
2. Accurate Coding: Ensure all services and procedures are coded correctly using the appropriate CPT, ICD-10, and HCPCS codes.
3. Establish Medical Necessity: Document the medical necessity for all services provided, including patient symptoms, diagnosis, and treatment rationale.
4. Maintain Complete Documentation: Keep comprehensive medical records, including progress notes, consultation reports, and test results.
5. Understand Policy Exclusions: Familiarize yourself with payer policies and exclusions to avoid submitting claims for non-covered services.
6. Prompt Resubmission: If a claim is denied due to code 246, make the necessary corrections and resubmit it without delay.

Optimize Your Revenue Cycle with Claims Med

By understanding the reasons behind denial code 246 and implementing the strategies outlined above, you can significantly reduce these denials and enhance your practice’s revenue cycle. Claims Med offers comprehensive revenue cycle management solutions tailored for healthcare providers. Our experts can assist you with claim scrubbing, appeals management, and other strategies to improve your financial health.

Get in touch with Claims Med today to discover how we can help your practice thrive!