117Denial Code (CARC)Active
Denial Code 117 - Transport to Closest Facility
Code 117 indicates that the transportation service billed was only covered to the nearest facility capable of providing the required care. If the transport exceeded that distance, the additional cost is not covered under the patient's insurance plan.
Who Pays: Group Code Liability
For code 117, the group code can be PR, meaning the patient can be billed for the additional cost of transport beyond the nearest qualifying facility.
Why Claims Get Code 117
- Transport was taken to a facility farther than the closest capable one.
- The service was billed without verifying the nearest appropriate facility.
- Patient or provider chose a preferred facility over the closest one.
- Insurance plan has specific distance limitations for transport coverage.
- Lack of authorization for transport to a farther facility.
How to Fix & Resubmit
- Verify the distance to the closest facility capable of providing necessary care.
- Check the patient's insurance policy for transport coverage details.
- Contact the payer to confirm if a correction or appeal is supported.
- If the transport was to the nearest capable facility, gather documentation to support this.
- Submit a corrected claim if billing errors are found, or appeal with supporting documentation if the decision is contestable.
Corrected Claim or Appeal?
Submit a corrected claim if the initial claim had errors in the facility details. Appeal with documentation if the transport was indeed to the nearest capable facility but denied in error.
Preventing Future 117 Denials
- Verify the closest capable facility before arranging transport.
- Document the medical necessity and facility details at the time of service.
- Educate staff on payer-specific transport coverage policies.
- Ensure pre-authorization procedures are followed for non-standard transports.