132Denial Code (CARC)Active
CO 132 Denial Code: Understanding & Resolving Adjustments
CARC 132 indicates that the adjustment on the claim is due to a prearranged demonstration project. This means the payment was altered based on specific terms outlined in a demonstration project agreement.
Who Pays: Group Code Liability
For CARC 132, the group code is typically CO, meaning the provider must write off the adjusted amount and cannot bill the patient. However, verify the demonstration project terms to confirm if any portion is patient responsibility under PR.
Why Claims Get Code 132
- The claim is part of a demonstration project with specific payment terms.
- The payer applied adjustments based on a prearranged project agreement.
- Incorrect billing not aligned with the demonstration project guidelines.
- Misunderstanding of the demonstration project terms by the billing office.
How to Fix & Resubmit
- Review the demonstration project agreement to understand the specific adjustment terms.
- Verify the claim was submitted correctly according to the project guidelines.
- Contact the payer to confirm the adjustment if the project terms are unclear.
- If the adjustment seems incorrect, gather supporting documentation for the demonstration project terms.
- Submit a corrected claim if the original submission didn't comply with the project terms.
Corrected Claim or Appeal?
For CARC 132, submit a corrected claim if the original was submitted incorrectly per the demonstration project terms. If the adjustment seems incorrect but was billed correctly, consider a formal appeal with documentation.
Preventing Future 132 Denials
- Ensure all billing staff are trained on the specifics of any demonstration projects the provider participates in.
- Set up reminder alerts for claims tied to demonstration projects to double-check terms before submission.
- Maintain a detailed record of all demonstration project agreements and terms.
- Regularly review payer guidelines for demonstration projects to stay updated.