Decoding Denial Code 131: A Quick Guide

Denial code 131, indicating a claim specific negotiated discount issue, can significantly impact your practice's revenue cycle. Understanding the root causes and implementing effective strategies can help prevent these denials.

Common Causes of Denial Code 131
Incorrect Discount Application: Errors in calculating or applying the negotiated discount percentage, or failing to consider contract limitations.

• Missing Documentation: Lack of necessary supporting documentation to justify the applied discount.
• Patient Eligibility Issues: Incorrectly determining if a patient qualifies for a specific discount.
• Billing Errors: Incorrect coding, claim submission errors, or applying negotiated rates to out-of-network services.
• Contractual Changes: Overlooking changes in the payer contract that affect discount terms.

Strategies to Prevent Denial Code 131

• Comprehensive Contract Management: Maintain an up-to-date database of all negotiated discounts, including specific terms, conditions, and limitations.
• Thorough Patient Verification: Verify patient eligibility for negotiated discounts before applying them to claims.
• Accurate Coding and Documentation: Ensure correct use of CPT, HCPCS, and ICD-10 codes, with detailed documentation to support claims.
• Timely Claim Submission: Adhere to payer-specific deadlines to avoid processing delays.
• Regular Contract Reviews: Stay informed about contract changes and updates to prevent compliance issues.
• Effective Communication: Establish clear communication channels with payers to address discrepancies and resolve issues promptly.
• Dedicated Denial Management: Implement a robust denial management process to identify and correct errors before resubmitting claims.

By understanding the common causes of denial code 131 and implementing these strategies, healthcare providers can significantly reduce the frequency of these denials and improve overall revenue cycle management.

Looking for Additional Support?
Claims Med offers specialized revenue cycle management solutions tailored to the needs of practice managers and healthcare providers. Our expertise in denial management, contract analysis, and claim optimization can help you maximize your revenue and improve your bottom line.

Don't let denial code 131 erode your practice's financial stability. Contact Claims Med today to schedule a consultation and learn how we can help you overcome this challenge.