224Denial Code (CARC)Active
CARC 224 Denial Code - Identity Theft Resolution
CARC 224 indicates that the patient's identity may have been stolen, leading to compromised identification. The payer requires identity verification before processing the current and any future claims for this patient.
Who Pays: Group Code Liability
With CARC 224, the group code is typically CO, meaning the provider must write off the amount. The patient cannot be billed for this adjustment, as it is related to identity verification issues.
Why Claims Get Code 224
- Patient's identity was used fraudulently to submit claims.
- Payer identified a discrepancy in patient identification information.
- Patient's insurance information was compromised.
- Patient's social security number was used unlawfully.
- Payer flagged the claim due to identity theft concerns.
How to Fix & Resubmit
- Contact the patient to inform them of the identity theft issue and the need for verification.
- Request the necessary identity verification documents from the patient, such as a government-issued ID.
- Submit the required identity verification documents to the payer as instructed.
- Once the patient's identity is verified, resubmit the corrected claim for processing.
- Monitor future claims for the same patient to ensure no further identity issues arise.
Corrected Claim or Appeal?
Submitting a corrected claim is appropriate once the patient's identity is verified. An appeal is not necessary unless the payer incorrectly flagged the identity issue.
Preventing Future 224 Denials
- Verify patient identification thoroughly at registration to prevent identity mix-ups.
- Implement regular audits to catch and correct any discrepancies in patient information.
- Educate patients on protecting their insurance information to prevent identity theft.
- Work with payers to quickly address and resolve flagged identity issues.