200Denial Code (CARC)Active
PR 200 Denial Code - Coverage Lapse Expenses
Code 200 indicates that the claim was denied because the expenses were incurred during a period when the patient did not have active insurance coverage. This means the patient's insurance policy was not in effect on the date of service billed.
Who Pays: Group Code Liability
With code 200, the group code is typically PR, meaning the patient is responsible for the charges since there was no active insurance coverage at the time of service. The provider can bill the patient for these charges.
Why Claims Get Code 200
- The patient had a gap in insurance coverage during the service date.
- The insurance policy lapsed due to non-payment of premiums.
- The patient did not renew their insurance policy on time.
- Incorrect insurance information was provided at the time of service, leading to a coverage lapse.
- A miscommunication between the patient and their employer or insurer about coverage dates.
How to Fix & Resubmit
- Verify the patient's insurance coverage dates for the time of service.
- Contact the patient to discuss the lapse in coverage and confirm if they have other insurance options.
- If the patient provides proof of active coverage for the date of service, update the insurance information and submit a corrected claim.
- If no active coverage was present, bill the patient for the incurred expenses.
- Document all communication with the patient regarding their coverage status for future reference.
Corrected Claim or Appeal?
Submit a corrected claim if the patient provides documentation showing active coverage during the service date. Otherwise, billing the patient is appropriate since the denial is valid under code 200.
Preventing Future 200 Denials
- Confirm insurance coverage dates during patient registration and prior to services being rendered.
- Regularly verify insurance policy status for patients with ongoing or recurring treatments.
- Educate patients on the importance of maintaining continuous insurance coverage.
- Implement a reminder system for patients to renew their insurance policies before expiration.