19Denial Code (CARC)Active
Denial Code 19: Worker's Comp Liability - Fix & Prevent
Code 19 indicates that the claim was denied because the service is related to a work injury or illness, and responsibility for payment lies with the Worker's Compensation Carrier. This means the claim submitted to the health insurance was rejected due to the need to bill Worker's Compensation instead.
Who Pays: Group Code Liability
For code 19, the group code PR is generally used, making it patient responsibility. However, since it's a work-related issue, the patient should not be billed directly; instead, the claim must be sent to the Worker's Compensation Carrier.
Why Claims Get Code 19
- The claim was submitted to regular health insurance instead of Worker's Compensation.
- Worker's Compensation information was not provided at the time of service.
- Incorrect insurance details were entered during patient registration.
- The patient did not inform the provider of the work-related nature of the injury or illness.
- Coordination of benefits was not updated to reflect Worker's Compensation as primary.
How to Fix & Resubmit
- Verify if the injury or illness is indeed work-related and ensure that Worker's Compensation information is on file.
- Obtain the correct Worker's Compensation Carrier details from the patient or employer.
- Update the patient's insurance information in the billing system to reflect Worker's Compensation as the primary payer.
- Resubmit the claim to the appropriate Worker's Compensation Carrier with any required documentation.
- If documentation is incomplete, contact the patient or employer to obtain necessary information for resubmission.
Corrected Claim or Appeal?
A corrected claim should be submitted to the Worker's Compensation Carrier. An appeal with the health insurer is not applicable as the denial is due to improper payer submission.
Preventing Future 19 Denials
- Ensure thorough patient intake processes capture any work-related injury details.
- Train front desk staff to ask about and document any work-related conditions during registration.
- Regularly update coordination of benefits information to ensure claims are submitted to the correct payer.
- Establish a protocol for verifying Worker's Compensation coverage before submitting claims to health insurance.