P26Denial Code (CARC)Active
CO P26 Denial Code - Understand & Address Adjustments
Code P26 indicates that the payment was adjusted due to the Voluntary Provider Network (VPN) agreement. This adjustment is specific to property and casualty claims. Depending on whether the adjustment is at the claim or line level, you'll need to refer to the appropriate segment in the 835 to understand the adjustment details.
Who Pays: Group Code Liability
Group code CO applies to code P26. This means it's a contractual write-off, and the patient cannot be billed for this adjustment.
Why Claims Get Code P26
- The provider is part of a Voluntary Provider Network (VPN) agreement that affects reimbursement rates.
- The claim is processed under property and casualty regulations.
- Incorrect understanding or setup of the VPN agreement terms in the billing system.
- Misinterpretation of the contract terms related to the VPN agreement.
- Failure to reference the appropriate segment in the 835 for claim or line level adjustments.
How to Fix & Resubmit
- Verify the claim is under property and casualty coverage with a VPN agreement.
- Review the 835 remittance advice to identify the specific segment (Loop 2100 or 2110) referenced for the adjustment.
- Check the terms of the VPN agreement to ensure the adjustment aligns with the contract.
- Contact the payer if the adjustment seems incorrect based on your contract terms.
- Document the adjustment as a contractual write-off in your billing system.
Corrected Claim or Appeal?
For code P26, submitting a corrected claim is not applicable since it's a contractual adjustment. An appeal is warranted only if there's an error in the application of the VPN terms.
Preventing Future P26 Denials
- Ensure accurate setup of VPN agreements in your billing system.
- Train staff to recognize and handle property and casualty claims correctly.
- Regularly review VPN contract terms for any changes or updates.
- Cross-check the 835 segments for claim and line level adjustments to prevent misinterpretation.