No-Fault Carrier Liability

What it means

The payer is denying this claim because they believe another insurer—specifically a no-fault auto insurance carrier—should be responsible for paying for this injury or illness, not them. This typically applies to claims related to motor vehicle accidents where no-fault insurance coverage exists.

Common causes

Patient was injured in a motor vehicle accident and has applicable no-fault auto insurance coverage
The claim was submitted to the wrong payer without first billing the no-fault carrier
Missing or incomplete accident/injury information on the claim that would clarify the correct payer
No-fault carrier information was not communicated to the billing office prior to claim submission
State-specific no-fault insurance laws apply to the patient's injury but were not accounted for in billing

How to fix it

Verify whether the patient has an active no-fault auto insurance policy related to this injury
Obtain the no-fault carrier's name, policy number, and claim number from the patient or accident report
Resubmit the claim to the correct no-fault carrier as the primary payer
Update the patient's insurance and accident information in your billing system for accurate coordination of benefits
If no no-fault coverage exists, contact the denying payer with documentation to clarify the situation and request reprocessing
Review state-specific no-fault insurance regulations, as rules vary by jurisdiction

Appeal / resubmit

If you believe this denial was issued in error—for example, if no no-fault coverage applies or the no-fault benefits have been exhausted—gather documentation such as the accident report, proof of no-fault claim denial or exhaustion of benefits, and any correspondence with the no-fault carrier. Submit an appeal with this supporting documentation to the original payer, clearly explaining why they should be considered the responsible party.

Related codes

Frequently asked

What does 'no-fault carrier' mean in this context?

A no-fault carrier is typically an auto insurance company that provides coverage for medical expenses resulting from a motor vehicle accident, regardless of who was at fault for the accident.

What should I do if the patient doesn't have no-fault insurance?

Contact the payer that issued this denial, provide documentation showing no no-fault coverage exists, and request that they reprocess the claim under their standard coverage terms.

Can this denial happen even if the injury wasn't from a car accident?

This code specifically relates to no-fault insurance, which is most commonly associated with auto accidents. If the injury is unrelated to a motor vehicle accident, this denial may indicate an error and should be reviewed with the payer.

More free billing tools: all denial codes · denial lookup · Medicare fee calculator

This content is informational only and does not constitute billing or legal advice. Always verify denial reasons and appeal procedures with the specific payer.