222Denial Code (CARC)Active
CO 222 Denial Code - Fix & Prevent Contractual Unit Errors
Code 222 on a remittance indicates that the claim exceeds the contracted maximum number of hours, days, or units allowed by the provider for the specified period. This denial is based on the provider's contract and is not related to any specific patient's benefits.
Who Pays: Group Code Liability
For CARC 222, the adjustment is typically a contractual obligation (CO), meaning the provider must write off the amount and cannot bill the patient.
Why Claims Get Code 222
- The provider's contract limits the number of units that can be billed for a specific service and this claim exceeded that limit.
- The billing system did not account for the maximum allowable units per period as specified in the provider contract.
- The claim was submitted with incorrect service dates, leading to an overlap in the billing period.
- The provider's understanding of the contract terms regarding unit limits was inaccurate or outdated.
How to Fix & Resubmit
- Verify the provider contract to confirm the maximum allowable units for the service period.
- Check the claim details for any errors in service dates or unit counts that could have caused the denial.
- Adjust the claim to reflect the correct number of units within the allowable limits if an error is found.
- If the claim is correct but the contract terms are outdated, contact the payer to discuss potential contract renegotiation or clarification.
- Resubmit the corrected claim if applicable, following any guidelines provided by the payer for such corrections.
Corrected Claim or Appeal?
For code 222, submit a corrected claim if there was a mistake in the original submission. If the denial is due to contract terms, an appeal is unlikely to succeed, as this is a contractual adjustment.
Preventing Future 222 Denials
- Regularly review and update the provider's contract terms in the billing system to ensure compliance with unit limits.
- Implement checks in the billing workflow to flag claims that exceed pre-set unit limits before submission.
- Train billing staff on the specifics of contract terms related to unit limits to prevent oversights.
- Schedule periodic contract reviews with payers to renegotiate terms as necessary to align with current service delivery needs.