238Denial Code (CARC)Active
PR 238 Denial Code: Coverage Period Adjustment
Code 238 indicates that the claim covers both eligible and ineligible periods of coverage. The adjustment amount reflects the portion of services provided during the ineligible period. It's a reduction specifically for the ineligible timeframe.
Who Pays: Group Code Liability
With group code PR applied to code 238, the patient is liable for the portion of services rendered during the ineligible period. This amount can be billed to the patient.
Why Claims Get Code 238
- The patient's insurance coverage lapsed during the service period.
- The patient transitioned to a new insurance plan mid-treatment.
- A retroactive termination of coverage was applied after services were rendered.
- The effective date of the patient's coverage was incorrectly recorded.
- Coordination of benefits was not updated, leading to coverage period errors.
How to Fix & Resubmit
- Verify the patient's coverage dates during the service period with the payer.
- Check if the patient had overlapping or changing insurance coverage during the claim period.
- If coverage was improperly terminated, contact the payer to correct the coverage period.
- Update the patient's insurance information in the billing system if needed.
- Resubmit the claim for the eligible period only, billing the ineligible portion to the patient.
Corrected Claim or Appeal?
A corrected claim is appropriate if coverage dates were initially entered incorrectly. If coverage genuinely lapsed, bill the patient for the ineligible period as indicated by PR group code.
Preventing Future 238 Denials
- Ensure accurate entry of patient coverage dates at registration.
- Verify insurance coverage status for the entire treatment period prior to service.
- Regularly update the patient's insurance information in the system to reflect any changes.
- Confirm coordination of benefits details are current and accurate.