27Denial Code (CARC)Active
Denial Code PR 27 - Coverage Termination Fix Steps
Code 27 indicates that the claim was denied because the services were provided after the patient's insurance coverage had ended. This means the payer will not reimburse these expenses as the policy was inactive at the time of service.
Who Pays: Group Code Liability
For code 27, the group code is typically PR, meaning the patient is responsible for the charges since the coverage was not active. However, verify with the payer as some circumstances might require a different approach.
Why Claims Get Code 27
- Patient's insurance coverage ended before the date of service.
- Incorrect insurance information was used, leading to a denial.
- Delay in updating insurance termination details in the system.
- Services provided under a canceled or expired policy.
- Miscommunication about the effective dates of coverage.
How to Fix & Resubmit
- Verify the patient's insurance coverage dates and ensure they were active during the service period.
- Check for any updated insurance information from the patient and confirm with the payer.
- If coverage was active, contact the payer to address potential errors in their records.
- Submit a corrected claim if insurance details were updated or verified as incorrect initially.
- Communicate with the patient to discuss responsibility if the coverage was indeed terminated.
Corrected Claim or Appeal?
Submit a corrected claim if insurance details were updated or verified as incorrect. If the coverage was legitimately terminated, billing the patient may be appropriate unless other payer-specific policies apply.
Preventing Future 27 Denials
- Verify insurance coverage dates at each patient visit.
- Update patient insurance information promptly in the system.
- Communicate with insurance companies regularly to track policy changes.
- Educate front-desk staff on the importance of confirming insurance coverage for each visit.