Denial Code P8 - Claim Under Investigation
Code P8 indicates that the claim is under investigation by the payer. This code applies specifically to Property and Casualty claims. When you see this code, refer to the 835 Insurance Policy Number Segment or Healthcare Policy Identification Segment for jurisdictional regulations or policy details, depending on whether the adjustment is at the claim or line level.
Who Pays: Group Code Liability
For code P8, the adjustment is typically marked as OA, indicating that it's an administrative hold and not a denial of payment. The patient should not be billed while the investigation is underway.
Why Claims Get Code P8
- The claim is being reviewed for compliance with jurisdictional regulations.
- Possible discrepancies in the claim details that require further investigation by the payer.
- The payer is verifying the accuracy of reported services against the policy.
- Potential issues with the insurance policy number or jurisdictional regulations.
- The claim involves complex case details needing additional scrutiny.
How to Fix & Resubmit
- Verify the Insurance Policy Number Segment or Healthcare Policy Identification Segment on the 835 to understand the specific jurisdictional requirements.
- Contact the payer to inquire about the nature of the investigation and any additional information needed.
- Check if any supporting documentation is required to expedite the review process.
- Monitor any updates from the payer regarding the status of the investigation.
- Maintain regular follow-up with the payer until the investigation is resolved and the claim is processed.
Corrected Claim or Appeal?
For code P8, submitting an appeal is not applicable since the claim is under investigation, not denied. Focus on providing any requested information and follow-ups to resolve the investigation.
Preventing Future P8 Denials
- Ensure all claim details are accurate and complete before submission, particularly for Property and Casualty claims.
- Stay updated with jurisdictional regulations relevant to the payer and claim type.
- Maintain clear communication with payers to promptly address any inquiries or requests for documentation.
- Implement a robust system to track and respond to claims under investigation efficiently.