66Denial Code (CARC)Active
PR 66 Denial Code - Blood Deductible Solutions
Code 66 indicates that a blood deductible has been applied to the claim. This means that the payer has determined that the patient is responsible for the cost of the blood deductible. It reflects a specific deductible amount related to blood services that the patient must pay before insurance coverage applies.
Who Pays: Group Code Liability
With code 66, the group code PR (Patient Responsibility) typically applies, meaning the patient is liable for the blood deductible amount. The provider can bill the patient for this deductible.
Why Claims Get Code 66
- The patient has not yet met their annual blood deductible.
- The blood deductible was not accounted for when calculating patient responsibility.
- A misunderstanding of the patient's benefits regarding blood services.
- Incorrect patient information leading to deductible misapplication.
How to Fix & Resubmit
- Verify the patient's insurance policy to confirm the blood deductible amount and whether it has been met.
- Check the patient's payment history to ensure no errors in deductible tracking.
- Contact the payer if there is a discrepancy in the deductible application.
- Update the patient's account to reflect any necessary payment or adjustments.
- Rebill the patient for the deductible amount if applicable.
Corrected Claim or Appeal?
For code 66, a corrected claim is unnecessary as the patient is responsible for the deductible. Appeals are typically not warranted unless there is a misapplication by the payer.
Preventing Future 66 Denials
- Verify patient benefits concerning blood deductibles during pre-registration.
- Ensure accurate tracking of patient payments against deductibles.
- Educate patients on their responsibility for specific deductibles, especially for blood services.
- Regularly update staff on insurance policy changes impacting deductibles.