How to work on denial code - 129 (Prior processing information appears incorrect)

This denial usually comes from secondary insurance (or Tertiary Insurance) for the below 2 reasons,

1. Primary insurance does not pay the claim.

2. Primary insurance has made the payment but payment information is incorrect on the claim form when billed to the secondary payer.

• Primary insurance does not pay the claim:

• The secondary payer pays the claim when primary insurance processed the claim properly. For example, If the claim is processed by primary insurance where a claim is allowed for $100, paid for $80 and PTR is $20 then secondary insurance is responsible to process the PTR of $20. 

• But if the claim is denied by the primary insurance and sent to the secondary payer then this denial occurs. In such a scenario, you will need to work on the denial received by primary insurance first.

• There are a few denials that get paid by secondary insurance such as non-covered charges as per the patient plan (or all PR denials). When primary insurance gives these denials then secondary may or may not pay the claim depending on policy benefit.

• Primary insurance has made the payment but payment information is incorrect on the claim form when billed to the secondary payer:

• If you found that primary insurance has made the payment correctly but still received this denial then always check the claim form to whether the primary payment information was sent correctly to secondary insurance or not. 

• You can find this information on the CMS form at box# 29 and on the UB-04 form at locator# 54.

• If the payment information is missing then you can resubmit the claim but do not forget to check the latest claim form. If the payment information is printing correctly now then it is correct. But if it is still missing then send the claim through fax or mailing address.