P11Denial Code (CARC)Active
OA P11 Denial Code - Pending Litigation Resolution
Code P11 indicates that the payment for a claim is delayed because the related Property & Casualty claim is pending litigation. This adjustment is specific to Property and Casualty claims, and you'll see it when there's a legal dispute affecting the claim's resolution.
Who Pays: Group Code Liability
For code P11, the group code OA applies, meaning it's an other adjustment. The patient should not be billed for this balance, as the claim is pending due to litigation.
Why Claims Get Code P11
- The patient is involved in a legal case concerning an injury or illness related to the claim.
- The Property & Casualty insurer is awaiting the outcome of litigation before settling the claim.
- Documentation regarding the legal case hasn't been submitted to the payer.
- The payer is holding the claim until the litigation is resolved.
How to Fix & Resubmit
- Verify the status of the litigation with the patient or their legal representative.
- Confirm with the Property & Casualty insurer that they are aware of the claim's pending status due to litigation.
- Ensure all necessary documentation related to the legal case is submitted to the payer.
- Contact the payer to confirm they have all required information and understand the claim is pending litigation.
- Monitor the legal case's progress and follow up with the insurer and payer as needed.
Corrected Claim or Appeal?
For code P11, a corrected claim is not appropriate because the claim's delay is due to pending litigation. Appeals are also not suitable unless there's a dispute about the litigation status.
Preventing Future P11 Denials
- Verify the legal status of related Property & Casualty claims before submission.
- Ensure all relevant documents and information are provided to the payer promptly.
- Communicate with the patient to understand any ongoing litigation that may affect claim processing.
- Coordinate with legal representatives to stay updated on the litigation's progress.