Unlocking the Mystery of Denial Code 246: A Guide for Practice Managers and Healthcare Providers

​Denial code 246 is a frequent roadblock in the revenue cycle, signifying a claim stopped before adjudication and returned unpaid. Addressing this challenge head-on can save your practice time, money, and frustration. In this article, we break down the causes of denial code 246 and provide actionable strategies to keep your revenue cycle healthy.
What is Denial Code 246?Denial code 246 refers to claims that have been halted before adjudication, meaning they weren’t processed for payment. While frustrating, understanding the underlying causes can empower healthcare providers and practice managers to take proactive steps.

Common Reasons Behind Denial Code 246

1. Incorrect Code Assignment: Errors in coding can result in non-payable claims for otherwise eligible services.
2. Lack of Medical Necessity: Claims for services that don’t meet medical necessity standards are often denied.
3. Insufficient Documentation: Incomplete or inaccurate medical records fail to justify the necessity of services provided.
4. Policy Exclusions: Services excluded under payer-specific policies are ineligible for reimbursement.
   
   

Strategies to Prevent and Resolve Denial Code 246

1. Conduct Thorough Claim Reviews: Regularly audit Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to catch denial code 246 claims early. Compare these to original claims to identify discrepancies.
2. Prioritize Accurate Coding: Use precise CPT, ICD-10, and HCPCS codes to ensure compliance and improve claim approval rates.
3. Document Medical Necessity Clearly: Provide comprehensive documentation, including patient symptoms, diagnoses, and treatment rationales.
4. Maintain Comprehensive Records: Ensure all medical records include detailed progress notes, test results, and consultation reports to support claims.
5. Understand Policy Exclusions: Stay informed about payer-specific exclusions to avoid submitting claims for non-covered services.
6. Act Quickly on Denials: Correct errors in denied claims and resubmit promptly to avoid revenue delays.
   
   

Why Claims Med?
Denial code 246 doesn’t have to derail your practice’s revenue cycle. With Claims Med, you gain access to expert guidance and tailored solutions to streamline your billing process and reduce claim denials.
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Take the first step towards financial health today. Contact Claims Med and let us help you maximize your revenue potential!