Documentation Requested

Common Causes for 252

Denials with code 252 typically happen for the following specific reasons:

• Failure to attach required clinical notes, progress reports, or test results that justify the medical necessity of the service.
• Missing prior authorization documentation or referral forms specifically requested by the payer.
• Incomplete or missing patient demographic/insurance information on claim forms or supporting documents.
• Omission of payer-specific forms or attachments (e.g., Medicaid-specific forms, specialty-specific documentation).
• Lack of supporting documentation for modifiers or codes indicating complexity or medical necessity.

How to Prevent 252 Denials

To avoid receiving this denial in the future, implement these specific checks:

• Implement a pre-claim checklist that verifies all required clinical notes, test results, and payer-specific forms are attached.
• Train staff to review payer-specific documentation requirements for each claim type and patient insurance plan.
• Conduct internal audits to ensure all claims include complete patient demographics, insurance details, and supporting clinical documentation.
• Use electronic claim management systems that flag missing attachments or incomplete fields before submission.
• Establish a process for double-checking prior authorization and referral documentation for every claim requiring it.

Appeal Letter Template for 252

If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.

[Your Practice Header]
[Date]

[Payer Name]
[Appeals Department Address]

RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: 252 - Documentation Requested

Dear Appeals Department,

I am writing to appeal the denial of the above-referenced claim, which was denied with code 252: "Documentation Requested".

The claim in question was submitted with appropriate procedural and diagnosis codes reflecting the clinical scenario and treatment rendered. Upon review, all documentation supporting the medical necessity of the service—including clinical notes, test results, and relevant prior authorizations—was available in the patient’s record and can be provided upon request. The denial under CO-252 appears to be based on a procedural documentation gap rather than a clinical determination of non-necessity. Given that the service aligns with payer coverage policies and clinical guidelines for the documented diagnosis, and that all required documentation can be supplied to substantiate the claim, reconsideration and payment are warranted. The absence of documentation at adjudication does not negate the appropriateness or necessity of the service provided, and timely submission of the requested records should resolve the issue.

Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].

We respectfully request that you reprocess this claim for payment.

Sincerely,

[Your Name]
[Title]
[Practice Name]