258Denial Code (CARC)Active
CO 258 Denial Code: Custody/Incarceration Coverage
Code 258 indicates that the claim or service is not covered because the patient was in custody or incarcerated at the time of service. It suggests that coverage may be available through a federal, state, or local authority instead.
Who Pays: Group Code Liability
For code 258, the group code is typically CO, meaning the provider must write off the amount and cannot bill the patient. However, if the payer's policy allows, it may be possible to pursue coverage through a governmental authority.
Why Claims Get Code 258
- Patient was in custody or incarcerated during the service date.
- The payer identified the patient's incarceration status from their records.
- The claim was submitted without verifying the patient's incarceration status.
- The provider did not bill the appropriate governmental authority for the incarcerated patient.
How to Fix & Resubmit
- Verify the patient's incarceration status on the date of service.
- Contact the payer to confirm the denial reason and inquire about any possible exceptions.
- Check if a governmental authority covers such services and determine the process to bill them.
- If applicable, submit the claim to the appropriate governmental authority.
- Document the payer's response and any actions taken for future reference.
Corrected Claim or Appeal?
For code 258, an appeal is generally not suitable unless you have evidence contradicting the incarceration status. If applicable, pursue billing with a governmental authority.
Preventing Future 258 Denials
- Verify the patient's custody status before claim submission.
- Update billing protocols to include steps for handling patients in custody.
- Establish communication with local authorities to understand coverage options.
- Train staff on identifying and managing claims for incarcerated patients.