P24Denial Code (CARC)Active
CO P24 Denial Code - PPO Adjustment Remedies
Code P24 indicates that the payment adjustment is due to the terms of a Preferred Provider Organization (PPO) contract. This adjustment is strictly for Property and Casualty claims. Depending on whether the adjustment is at the claim or line level, you should refer to the 835's specific segments for more details.
Who Pays: Group Code Liability
Code P24 uses the CO group code, meaning it is a contractual obligation. The provider must write off the adjusted amount, and the patient cannot be billed for it.
Why Claims Get Code P24
- The claim was processed under a PPO contract, resulting in a lower payment.
- The payer applied a contracted rate adjustment at the claim level.
- The payer applied a contracted rate adjustment at the line level.
- The claim was submitted to a Property and Casualty insurer with a PPO agreement.
How to Fix & Resubmit
- Verify the PPO contract terms to ensure the adjustment aligns with the agreed rates.
- Check the 835 remittance advice for the relevant contract code in the specified loop.
- If the adjustment seems incorrect, contact the payer for clarification on the PPO terms applied.
- Document the adjustment reason and ensure the write-off is applied correctly to the patient account.
Corrected Claim or Appeal?
For code P24, a formal appeal is rarely appropriate unless there's a discrepancy in the PPO terms applied. If you find an error, first verify contract details with the payer before considering an appeal.
Preventing Future P24 Denials
- Ensure PPO contract terms are correctly loaded into the billing system.
- Regularly update contract terms to reflect any changes in PPO agreements.
- Train staff to recognize contract-related adjustments and verify them promptly.
- Review remittance advice carefully to catch any discrepancies early.