P20 Denial Code - Fix & Prevent Outpatient Facility Errors
CARC P20 indicates that the service was not paid under the jurisdiction's allowed outpatient facility fee schedule, specifically for Property and Casualty claims. This typically means the service does not align with the fee schedule requirements or has been deemed ineligible for payment under these regulations.
Who Pays: Group Code Liability
For CARC P20, the liability generally falls under the CO group code, meaning it is a contractual write-off and the patient should not be billed for this amount. This reflects the payer's determination that the service is not payable under the specified fee schedule.
Why Claims Get Code P20
- The service provided is not covered under the Property and Casualty outpatient facility fee schedule.
- Incorrect billing of a service that is not recognized by the jurisdiction's fee schedule.
- Coding errors where the wrong service code was submitted for a Property and Casualty claim.
- Submission of a claim to the wrong jurisdiction that does not recognize the service under its fee schedule.
- Misinterpretation of the jurisdiction's outpatient facility coverage policies.
How to Fix & Resubmit
- Verify the service code used against the jurisdiction's outpatient facility fee schedule for Property and Casualty claims.
- Ensure the claim was submitted to the correct jurisdiction that covers the service under its fee schedule.
- Check for any coding errors that may have led to this denial, especially service code inaccuracies.
- Contact the payer to confirm the specific reason the service was not payable under their fee schedule.
- If applicable, correct any errors and submit a corrected claim to the appropriate jurisdiction.
Corrected Claim or Appeal?
For CARC P20, a corrected claim is appropriate if there was an error in coding or jurisdiction submission. If the denial is due to the service not being covered under the fee schedule, an appeal is unlikely to succeed unless there is a compelling reason.
Preventing Future P20 Denials
- Ensure all services billed are covered under the jurisdiction's outpatient facility fee schedule for Property and Casualty claims.
- Regularly update fee schedule knowledge to prevent billing of non-covered services.
- Verify jurisdictional requirements before claim submission to avoid jurisdictional mismatches.
- Train staff on specific Property and Casualty billing rules to reduce coding errors.