The worst nightmare that any healthcare practice can imagine is receiving a claim denial. Not only does it take extra time and resources to reverse or appeal these denials, but it also costs the practice financially. According to the Journal of AHIMA, it costs between $25 and $181 to rework a rejected claim. That’s why practices look for ways to avoid a claim denial. But for that, they must understand the denial codes, the reasons behind them, and the ways to prevent them.
In this blog, we will discuss the PR 32 denial code. To find out more about the meaning of this code and how to properly handle it, keep reading.
PR 32 Denial Code – Description
Denial code 32 indicates that, according to the insurance payer records, the patient is not eligible as a dependent.
To put it simply, the payer has rejected the claim since the patient is not covered as a dependent under the policy. This may happen because the patient does not meet the criteria or requirements to be covered under the insurance plan as a dependent of the policyholder.
What Causes the PR 32 Denial Code?
So, why is a claim returned with a PR 32 denial? The following are a few common reasons for the denial code 32.
Incorrect Patient Information
The most common cause of a denial code PR 32 is inaccurate patient information. It occurs when billers submit claims using an inaccurate insurance number, patient name, spelling, or birthdate. Due to such minor errors, the payer cannot find the patient’s information in their records and fails to verify the patient’s dependent status. This immediately leads to a PR 32 denial.
Expired Insurance
Billers usually submit claims to the payer without realizing the patient’s coverage has expired or the payer has terminated the insurance coverage. The expiry of the coverage also affects the patient’s dependent status. If the patient is no longer eligible for dependent coverage, the payer will deny the claim with the denial code 32.
Inadequate Documentation
This denial may also occur due to a lack of supporting documentation that proves the patient’s dependent status, such as legal guardianship, birth certificates, or marriage certificates. Not providing these documents with the claim may also result in a denial.
Insurance Policies Changes
Insurance payers constantly update and change their policies. This action can impact the patient’s dependent status. Claims that were formerly covered by the payer may be denied with the PR 32 denial code if updated policies make the patient ineligible for dependent status.
How to Prevent Denial Code PR 32?
Here is how you can prevent the PR 32 denials on your claims.
Verify Patient Eligibility
The best and most effective way to avoid this denial is to verify the patient’s eligibility with the insurance payer. Since payers frequently update and modify the status of patients, it is recommended to verify insurance status prior to filing claims. This ensures that the patient’s coverage is active for the precise date of service.
Update Patient Information
Another key step is to collect and update insurance information at every patient encounter. Front-desk staff should ask and verify the latest insurance card and confirm details such as policy number, group number, and the insured party’s information. This simple habit can significantly reduce the number of PR 32 denials, which occur due to outdated or incorrect records.
Stay Updated with Policies
Last but not least, train your staff to keep up with the latest updates of insurance payers. They must verify when the plan starts and expires, and whether the scheduled service falls within that period. Patients must be informed of any changes to the policies so they are aware of their financial obligations.
How to Resolve Denial Code 32?
How can you fix a denial code PR 32 that you have received? Here is a step-by-step approach to resolving this denial code.
- First, verify the patient’s eligibility and dependent status by checking their insurance coverage details.
- Gather more information about the patient’s eligibility status.
- Contact the insurance payer.
- Update the patient’s data in your system if the denial was caused by a change in their dependent status.
- Submit an appeal if the patient is an eligible dependent with the required supporting documents.
- Regularly take follow-ups with the insurance payer until the denial code 32 is resolved.
Final Thoughts
Phew! After reading this whole blog, we are sure that you can handle the PR 32 denial code. We have made an effort to educate you about the possible causes of the denial and how to avoid them. We have also outlined the step-by-step actions you can take to resolve this denial code.
Nevertheless, we are aware that dealing with claim denials might be challenging due to work-related stress. We also have a solution to this issue. You can hire expert denial management services from NeuraBill. Their billing specialists are skilled in accurately filing claims and handling rejections.
