Denial Code Search

Procedure code inconsistent with modifier

Contractual Obligation · Coding

Procedure code inconsistent with place of service

Contractual Obligation · Coding

Procedure/revenue code inconsistent with patient's age

Contractual Obligation · Coding

Procedure/revenue code inconsistent with patient's gender

Contractual Obligation · Coding

Procedure code inconsistent with provider type/specialty

Contractual Obligation · Provider Enrollment

Diagnosis inconsistent with patient's age

Contractual Obligation · Coding

Diagnosis inconsistent with procedure

Contractual Obligation · Coding

Date of death precedes date of service

Contractual Obligation · Eligibility

Missing or invalid authorization number (deactivated code)

Contractual Obligation · Authorization

Claim lacks information or has submission error

Contractual Obligation · Documentation

Exact duplicate claim/service

Contractual Obligation · Duplicate

Injury is work-related — workers' comp liability

Contractual Obligation · Coordination of Benefits

Injury covered by liability carrier

Contractual Obligation · Coordination of Benefits

Injury covered by no-fault carrier

Contractual Obligation · Coordination of Benefits

Care may be covered by another payer (COB)

Contractual Obligation · Coordination of Benefits

Impact of prior payer adjudication

Contractual Obligation · Coordination of Benefits

Covered under capitation agreement / managed care plan

Contractual Obligation · Eligibility

Expenses incurred prior to coverage

Contractual Obligation · Eligibility

Expenses incurred after coverage terminated

Contractual Obligation · Eligibility

Timely filing limit expired

Contractual Obligation · Timely Filing

Lifetime benefit maximum reached

Contractual Obligation · Eligibility

Services denied at time authorization was requested

Contractual Obligation · Authorization

Charges do not meet qualifications for emergent/urgent care

Contractual Obligation · Medical Necessity

Charge exceeds fee schedule / contracted rate

Contractual Obligation · Contractual

Routine/screening service non-covered

Contractual Obligation · Coding

Not deemed medically necessary

Contractual Obligation · Medical Necessity

Non-covered — pre-existing condition

Contractual Obligation · Eligibility

Multiple physicians/assistants not covered

Contractual Obligation · Coding

Experimental/investigational procedure

Contractual Obligation · Medical Necessity

Treatment rendered in inappropriate/invalid place of service

Contractual Obligation · Medical Necessity

Processed based on multiple/concurrent procedure rules

Contractual Obligation · Contractual

Plan procedures not followed

Contractual Obligation · Authorization

Non-covered charge(s)

Contractual Obligation · Eligibility

Bundled — included in another service's payment

Contractual Obligation · Coding

Related/qualifying claim not identified on this claim

Contractual Obligation · Documentation

Claim not covered by this payer/contractor

Contractual Obligation · Eligibility

Billing date predates service date

Contractual Obligation · Documentation

Benefit maximum reached

Contractual Obligation · Eligibility

Diagnosis was invalid for the date of service

Contractual Obligation · Coding

Level of service not supported

Contractual Obligation · Documentation

Payment adjusted — frequency of services

Contractual Obligation · Medical Necessity

Diagnosis not covered

Contractual Obligation · Medical Necessity

Payment denied for this provider type

Contractual Obligation · Provider Enrollment

Procedure code invalid on date of service

Contractual Obligation · Coding

Procedure modifier invalid on date of service

Contractual Obligation · Coding

Precertification/authorization absent

Contractual Obligation · Authorization

Precertification/authorization exceeded

Contractual Obligation · Authorization

Revenue code and procedure code do not match

Contractual Obligation · Coding

Service not covered under current benefit plan

Contractual Obligation · Eligibility

Exceeds contracted maximum hours/days/units

Contractual Obligation · Contractual

Information requested from billing provider not provided

Contractual Obligation · Documentation

Information requested from patient not provided

Contractual Obligation · Coordination of Benefits

Mutually exclusive procedures — same day/setting

Contractual Obligation · Coding

Procedure combination not compatible

Contractual Obligation · Coding

Services not provided by network/primary care providers

Contractual Obligation · Eligibility

Services not authorized by network/primary care providers

Contractual Obligation · Authorization

Attachment/documentation required

Contractual Obligation · Documentation

Service not payable per managed care contract

Contractual Obligation · Contractual

Referral absent

Contractual Obligation · Authorization

Claim/service denied — see remark codes

Contractual Obligation · Documentation

Required qualifying service not received

Contractual Obligation · Coding

Provider not certified/eligible for this service

Contractual Obligation · Provider Enrollment

Patient enrolled in hospice

Contractual Obligation · Eligibility

Duplicate claim (other adjustment)

Other Adjustment · Duplicate

Prior payer adjudication impact (other adjustment)

Other Adjustment · Coordination of Benefits

Not covered under benefit plan (payer initiated)

Payer Initiated Reduction · Eligibility

Deductible amount

Patient Responsibility · Patient Responsibility

Coinsurance amount

Patient Responsibility · Patient Responsibility

Copayment amount

Patient Responsibility · Patient Responsibility

Expenses incurred after coverage terminated (patient liability)

Patient Responsibility · Eligibility

Patient cannot be identified as insured

Patient Responsibility · Eligibility

Not covered under benefit plan (patient liability)

Patient Responsibility · Patient Responsibility