229Denial Code (CARC)Active
PR 229 Denial Code - Medicare Bypass Fixes
Code 229 indicates that Medicare has not considered part of the charge amount because the initial claim was submitted with a Type of Bill 12X. This adjustment is relevant when the secondary payer's cost avoidance policy allows bypassing submission to the primary payer.
Who Pays: Group Code Liability
For code 229, the group code PR is used, making the patient responsible for the amount not considered by Medicare. Providers may bill the patient for this amount.
Why Claims Get Code 229
- The claim was submitted with a Type of Bill 12X, which is not fully processed by Medicare.
- The secondary payer permits bypassing the primary payer, triggering code 229.
- The provider did not submit the claim to the primary insurance before billing Medicare.
- An incorrect claim type was selected when submitting to Medicare.
How to Fix & Resubmit
- Verify that the Type of Bill on the original claim was correctly entered as 12X.
- Check if the secondary payer's policy allows bypassing the primary payer and if so, confirm compliance with their requirements.
- Ensure that the claim was correctly submitted to the primary insurance if required by the secondary payer.
- If the Type of Bill was incorrect, adjust it appropriately and resubmit the claim to Medicare for consideration.
- Contact the secondary payer for guidance if their cost avoidance policy was misunderstood.
Corrected Claim or Appeal?
For code 229, submit a corrected claim if the Type of Bill was entered incorrectly. If the secondary payer's policy was misunderstood, an appeal may be necessary after clarification.
Preventing Future 229 Denials
- Ensure accurate selection of the Type of Bill before claim submission to Medicare.
- Review the secondary payer's cost avoidance policy to understand submission requirements.
- Train staff on correctly identifying when to bypass the primary payer.
- Implement a checklist for claim submissions to verify all details, including Type of Bill, are correct.