Auto insurance deny the claim - PIP benefits exhausted

WC Denials - PIP BENEFITS EXHAUSTED  

    This rejection is common in Auto insurance claim.  PIP stands for Personnel Injury Protection. This rejection indicates that the carrier’s liability towards PIP of the subscribers has been exhausted.

    Action: When you get this rejection, see whether the patient has any secondary coverage like Medical coverage ex. Medicare united, Medicaid, etc. if yes, check with the carrier whether they will be processing the claim as primary if the primary rejection is attached and sent to them. If no, then the patient has to be billed.

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How to prevent the denial

Denial Explanation

Claim/service denied because Medicare cannot pay for the diagnosis/diagnoses on the claim. Denied based on a LCD. Provider liable.

How to Prevent These Denials

These are automated denials. LCDs include a list of covered diagnoses. The diagnosis codes on the claim are compared to the procedure code billed to determine if the services are covered by the LCD. When submitting a claim for payment, code all applicable diagnoses on the claim. Include the final diagnosis as well as
signs and symptoms.

Denial Explanation

Claim/service denied per the NCD module because the diagnosis/diagnoses on the claim did not support the medical necessity for the service. Provider liable


These are automated denials. The laboratory NCDs include a list of covered diagnoses. The  diagnosis codes on the claim are compared to the procedure code billed to determine if the services
are covered by the NCD. When submitting a claim for payment, code all applicable diagnoses on the claim. Include the final diagnosis as well as signs and symptoms.

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