PI 27 – Expenses Incurred After Insurance Coverage Terminated

The PI-27 denial code indicates that the payer denied or adjusted the claim because the patient's insurance coverage had terminated before the date of service. The PI (Payer Initiated) group code identifies an adjustment made according to the payer's eligibility records rather than patient responsibility or contractual obligations.

Providers should verify the patient's coverage dates, insurance eligibility, and payer responsibility before determining whether to submit a corrected claim or appeal.

Quick Facts

Denial Code
PI-27

Group Code
PI (Payer Initiated)

Category
Coverage Termination

Meaning
The patient's insurance coverage ended before the billed service was provided

Common Payers
Medicare, Medicaid, and Commercial Insurance

Next Step
Verify the patient's eligibility and determine whether another insurance plan should be billed

What Does PI-27 Mean?

The PI-27 denial code indicates that the payer determined the patient's insurance policy was no longer active on the date the healthcare service was performed.

This denial commonly occurs when insurance information has not been updated or when a patient changes employers, health plans, or coverage before receiving treatment.

Providers should review the patient's insurance records and any accompanying RARC codes before taking further action.

Common Causes

Providers may receive the PI-27 denial code when:

• Insurance coverage terminated before the date of service.

• The patient changed insurance plans.

• Outdated insurance information was used.

• The wrong insurance payer was billed.

• Eligibility was not verified before the appointment.

• Patient registration records were not updated.

How To Resolve PI-27

If you receive the PI-27 denial code:

• Verify the patient's insurance eligibility.

• Confirm the policy termination date.

• Determine whether another insurance plan was active.

• Update the patient's insurance information.

• Submit the claim to the correct payer if appropriate.

• Appeal the denial if documentation supports active coverage.

Verifying insurance before every patient visit helps prevent this type of denial.

Common Billing Mistakes

Common issues associated with PI-27 include:

• Billing inactive insurance coverage.

• Failing to verify eligibility before services.

• Missing updated insurance information.

• Submitting claims to the wrong payer.

• Not confirming coverage changes during patient registration.

Frequently Asked Questions

How is PI-27 different from PI-26?

PI-27 specifically indicates that the patient's insurance coverage ended before the date of service, while PI-26 generally refers to services provided outside the active coverage period, including both before coverage begins and after it ends.

Can another insurance policy be billed after receiving PI-27?

Yes. If the patient had another active insurance policy on the date of service, the claim may be submitted to the correct payer after verifying eligibility.

Should providers always verify insurance before treatment?

Yes. Confirming active coverage before each patient visit is one of the most effective ways to prevent PI-27 denials.

Can PI-27 be appealed?

Yes. If the payer's eligibility records are incorrect or the provider has documentation showing active coverage, an appeal may be appropriate.

Related PI Codes

You may also encounter:

• PI-26 Denial Code

• PI-22 Denial Code

• PI-109 Denial Code

• PI-204 Denial Code

Quick Summary

The PI-27 denial code indicates that the patient's insurance coverage had terminated before the billed service was provided. Verifying eligibility, confirming coverage dates, and submitting claims to the correct payer can help providers resolve the denial and reduce future eligibility-related claim issues.