PR 27 denial code description – expenses incurred after patient’s insurance coverage terminated.
CO or PR 27 is one of the most common denial code in medical billing. Insurance company denies the claim with denial code 27 when patient policy wasn’t active on Date of Service. It occurs when provider performed healthcare services to the patient after member insurance plan terminated.
Insurance Denial Code PR 27 – Reasons and Solution
Below, we will thoroughly discuss the reasons, solution and how to fix PR 27 denial.
Reasons of PR 27 Denial
CO or PR 27 denial code occurs when physician provide healthcare services to the patient on Date of Service for which patient insurance plan wasn’t active. So, when medical biller bills claim for that DOS to the healthcare insurance company, insurance denies it with reason code CO-27 OR PR-27.
How to avoid PR 27 Denial?
As I mentioned earlier that PR 27 is one of the most common denial code which causes delay in provider payments so it’s necessary to avoid it for healthy RCM. Here is a tip to avoid CO 27 denial. When patient comes for appointment and provides his insurance information, make sure to check his eligibility and coverage date span.
Checking patient eligibility and coverage date span helps you to get up-to-date and active insurance information from patient on time which helps to avoid CO-27 denial code because sometimes pr27 denial code can also lead to CO 29 denial code of timely filing limit.
Solution of PR 27 denial
Kindly do the below-mentioned action when CO 27 denial code occurs:
1. Check patient eligibility via insurance portal or call insurance patient eligibility department to verify member policy active and termination date.
2. After verifying eligibility through insurance website or CSR, if you find that patient plan is active then resubmit claim to the insurance company. In case you are verifying eligibility on live call then ask insurance customer care representative to reprocess the claim.
While working on UHC insurance claims, you may need United Healthcare contact information
3. In case, patient plan was not active on date of service then first of all, check patient documents to find if there is any other active insurance policy on DOS. If no other active insurance plan found in system then call the patient for active insurance info.
4. If any other active insurance plan found then in patient record or through call update active insurance information in patient demographics as well as claim and resubmit claim to the correct payer.
5. If member does not have any active insurance plan on Date of Service then bill it to the patient.
How to discuss PR 27 denial code with insurance representative on call?
If you call insurance claims department regarding insurance termination denial, ask the following questions!
1. May I know member healthcare plan effective and termination date?
2. If insurance policy is active on Date of Service, inform the representative that claim processed incorrectly and denial isn’t correct. So, kindly review and reprocess the claim.
3. If insurance policy is not active on Date of Service, ask the representative if there is any other active insurance plan on Date of Service for patient. If found, ask the representative to reprocess the claim with patient correct insurance ID OR resubmit the corrected claim manually with new active member ID.
4. Get denied claim number and denial date. Also, if any other active plan found the get insurance active ID#, insurance address, insurance phone number and claims submission address for electronic and paper submission.
Final Step to Resolve PR 27 denial
Many people forget this step but it is the most crucial. Make sure to verify eligibility of newly obtained member ID before claim submission. It is necessary to make sure the member plan is active to avoid another insurance termination denial.
Hi, I’m Kim Keck! Born in Texas, USA. I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. Right after completing my degree in 2011, I started my job career as an Accounts Receivable in a medical billing company.
Now, with more than 15 years of experience as a medical biller and revenue cycle manager, I am on a mission to serve the medical billing industry with my vast knowledge and years of expertise.