Denial Code P2: Workers' Comp Liability Guide
Code P2 indicates that a claim was denied because the injury or illness in question is not considered work-related, and therefore, it is not the responsibility of the workers' compensation carrier. The payer's decision is based on jurisdictional regulations and is detailed in the 835 Insurance Policy Number Segment or the Healthcare Policy Identification Segment, depending on whether the adjustment is at the claim or line level.
Who Pays: Group Code Liability
For code P2, if the group code is CO, the denial is a contractual write-off and the patient cannot be billed. If the group code is PR, the patient may be responsible for the charge, and you can bill the patient.
Why Claims Get Code P2
- The injury or illness was determined not to be work-related after review.
- Incorrect claim submission indicating the injury was work-related.
- Lack of supporting documentation proving the injury is work-related.
- The jurisdictional regulations do not support a workers' compensation claim for this condition.
- The payer's records indicate the patient does not have valid workers' compensation coverage.
How to Fix & Resubmit
- Verify the claim details against the patient's employment and injury records to ensure accuracy.
- Check the accompanying 835 segments for jurisdictional regulation details, as indicated by the payer.
- Gather any missing documentation that proves the injury is work-related, if applicable.
- Contact the payer for clarification on why the injury was determined not to be work-related.
- If applicable, resubmit the claim with corrected information or additional documentation.
Corrected Claim or Appeal?
If the denial is based on incorrect information or missing documentation, submit a corrected claim. If you have evidence contradicting the payer's determination, a formal appeal may be necessary. If the denial adheres to jurisdictional regulations, it may be a legitimate adjustment.
Preventing Future P2 Denials
- Ensure all claims related to workers' compensation include comprehensive documentation proving the injury is work-related.
- Verify injury details against workers' compensation coverage before claim submission.
- Educate staff on the importance of accurately identifying work-related injuries during patient intake.
- Establish a checklist for workers' compensation claims to prevent submission errors.