P12Denial Code (CARC)Active
CO P12 Denial Code - Workers' Comp Fee Schedule Fix
Code P12 indicates that the payment adjustment is due to a workers' compensation jurisdictional fee schedule. This adjustment can occur at either the claim or line level, and it reflects compliance with specific workers' compensation regulations. The payer should provide additional details in the appropriate segments of the 835 remittance advice.
Who Pays: Group Code Liability
For code P12, the adjustment typically falls under group code CO, meaning it's a contractual obligation and the provider must write it off. The patient cannot be billed for this adjustment.
Why Claims Get Code P12
- The service was billed above the workers' compensation fee schedule.
- Incorrect jurisdictional fee schedule applied to claim.
- Claim submitted with incorrect workers' compensation information.
- Payer-specific workers' compensation rules not followed.
- Provider's contract with the payer requires adjustments to match fee schedule.
How to Fix & Resubmit
- Review the remittance advice to identify whether the adjustment is at the claim or line level.
- Check the 835 Class of Contract Code Identification Segment or Healthcare Policy Identification Segment for details on the fee schedule adjustment.
- Verify the billed amount against the correct jurisdictional fee schedule for workers' compensation.
- If the fee schedule applied was incorrect, contact the payer for clarification or correction.
- Adjust the claim in your system to reflect the write-off if the adjustment is valid.
Corrected Claim or Appeal?
For code P12, filing an appeal is not warranted if the adjustment aligns with the jurisdictional fee schedule. Corrections are necessary only if the wrong fee schedule was applied.
Preventing Future P12 Denials
- Ensure all workers' compensation claims are billed according to the correct jurisdictional fee schedule.
- Regularly update your system with the latest workers' compensation fee schedules.
- Verify workers' compensation details and payer-specific rules before submitting claims.
- Train billing staff on identifying and applying correct fee schedules for workers' compensation.