Wiki PR272

[MDiaz77]

I had a denial for a comanage Cataract Surgery and the insurance deny as PR272: Coverage/program guidelines were not met. What did I did wrong?

 

[thomas7331]

I had a denial for a comanage Cataract Surgery and the insurance deny as PR272: Coverage/program guidelines were not met. What did I did wrong?

This is a very generic denial message - if this is the only information that was included with the denial, then I think you are going to have no choice but to contact the payer and ask them to explain it. You haven't necessarily done anything wrong. The PR indicates that the charges are the patient's responsibility, so this might possibly have something to do with the patient not following the plan's restrictions on what providers they can go to for care.

 

[MDiaz77]

Thank you for your help, I will call the insurance