P28 Denial Code: Fix Liability Coverage Adjustments
Code P28 indicates that the payment adjustment is due to jurisdictional regulations or payment policies specific to Liability Coverage Benefits in Property and Casualty Auto claims. This adjustment can occur at either the claim level or the line level, and it reflects compliance with specific jurisdictional rules governing these types of claims.
Who Pays: Group Code Liability
For code P28, the group code typically applied is CO, meaning that the adjustment is a contractual obligation and the provider must absorb the cost, not the patient. The patient should not be billed for this adjustment.
Why Claims Get Code P28
- The claim was processed under a jurisdiction with specific auto liability coverage rules.
- A discrepancy in the insurance policy number or jurisdictional information led to an adjustment.
- The payer applied local state regulations affecting the payment amount.
- Incorrect or missing policy information in the claim submission.
- The service provided falls under specific state-mandated coverage limits.
How to Fix & Resubmit
- Verify the insurance policy number and jurisdictional information in the claim submission.
- Check the payer's specific jurisdictional regulations and payment policies related to Property and Casualty Auto claims.
- Confirm that all required information in Loop 2100 or Loop 2110 is complete and accurate.
- If information was missing or incorrect, update the claim with the correct details and resubmit.
- Contact the payer for clarification if the jurisdictional regulation or payment policy is not clear.
Corrected Claim or Appeal?
For code P28, if the adjustment is due to missing or incorrect jurisdictional information, submit a corrected claim. If the adjustment complies with state regulations, an appeal is unlikely to succeed.
Preventing Future P28 Denials
- Ensure accurate entry of insurance policy numbers and jurisdictional details during claim registration.
- Stay updated on state-specific payment policies for auto liability coverage.
- Use claim management software to flag jurisdictional requirements for Property and Casualty Auto claims.
- Regularly train billing staff on compliance with jurisdictional regulations.