P23Denial Code (CARC)Active
P23 Denial Code - Fix Fee Schedule Adjustments
Code P23 indicates that the payment was adjusted due to a jurisdictional fee schedule related to Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) benefits. This adjustment is specific to property and casualty auto claims. The payer's adjustment is based on regulations that determine the allowable payment amount for these types of claims.
Who Pays: Group Code Liability
For code P23, the adjustment typically falls under the CO group code, meaning it is a contractual write-off and the patient cannot be billed for the difference.
Why Claims Get Code P23
- The initial claim submission did not consider the jurisdictional fee schedule for MPC or PIP benefits.
- Incorrectly coding the claim type as non-auto when it pertains to property and casualty auto.
- Failure to reference the correct 835 segments as required (Loop 2100 or 2110) for jurisdictional adjustments.
- Submitting claims without acknowledging state-specific auto insurance regulations.
- Overlooking to verify the specific auto insurance policy terms related to MPC or PIP.
How to Fix & Resubmit
- Review the 835 remittance advice to identify the applicable jurisdictional fee schedule adjustments in Loop 2100 or 2110.
- Verify the claim was correctly coded as a property and casualty auto claim under MPC or PIP.
- Check the state-specific fee schedule or regulations that apply to the claim to ensure compliance.
- If the claim was incorrectly submitted, correct the claim details and resubmit.
- Contact the payer if additional clarification on the jurisdictional adjustment is needed.
Corrected Claim or Appeal?
For code P23, if the jurisdictional fee schedule was not followed, correct and resubmit the claim. Appeal is warranted if you believe the adjustment was applied incorrectly despite correct submission.
Preventing Future P23 Denials
- Always verify and apply the correct jurisdictional fee schedule for MPC or PIP claims.
- Ensure claims are accurately coded as property and casualty auto claims.
- Regularly update billing staff on state-specific regulations for auto insurance claims.
- Implement checks to confirm correct referencing of 835 segments (Loop 2100 or 2110) for these adjustments.