P17Denial Code (CARC)Active
CARC P17 Denial Code - Fix Referral Authorization Issues
CARC P17 indicates that a referral was not authorized by the attending physician, which is necessary under regulatory requirements for Property and Casualty claims. This adjustment means the claim lacks the required referral documentation from the attending physician.
Who Pays: Group Code Liability
For CARC P17, the liability typically falls under CO, meaning the provider must write off the amount and cannot bill the patient. Since this pertains to regulatory requirements, PR is generally not applicable.
Why Claims Get Code P17
- Lack of referral authorization from the attending physician.
- Failure to meet regulatory requirements for Property and Casualty claims.
- Miscommunication between the attending physician and billing office regarding referral needs.
- Submission of a claim before obtaining the necessary referral.
- Incorrect documentation of referral in the patient's records.
How to Fix & Resubmit
- Verify if the referral authorization was obtained from the attending physician.
- Check the patient's records and communication logs for any missing or incomplete referral documentation.
- Contact the attending physician's office to secure the necessary referral authorization if it was not initially provided.
- Once the referral is obtained, submit a corrected claim with the proper documentation.
- If the referral cannot be obtained, adjust the account according to CO guidelines.
Corrected Claim or Appeal?
For CARC P17, submit a corrected claim if you can secure the referral authorization. An appeal is generally not successful without the necessary documentation, as this is a regulatory requirement.
Preventing Future P17 Denials
- Ensure all referrals are authorized by the attending physician before claim submission.
- Implement a checklist for regulatory requirements specific to Property and Casualty claims.
- Regularly train staff on the importance of obtaining and documenting referrals for these claims.
- Establish a direct communication line with attending physicians' offices for referral verification.