Medical Billing and Coding Resources
Fixing claim rejections is not difficult once you know the reasons behind it. Note that since each payer/clearinghouse words the rejection message differently, there may be multiple messages listed for one entry. Payer ID Missing or Invalid This rejection is stating that the payer ID that was used on the claim is not valid for […]
Millions of claims were denied because eligibility had expired or the patient or service was not covered by the plan. Maintaining a consistent and accurate verification process is essential to maintaining a healthy revenue cycle. Physicians need to verify each patient’s eligibility and benefits to ensure they will receive payment for services rendered. Insurance should […]
CO18 Denial Code: Duplicate Claim/Service Duplicate denials continue to be one of the top billing errors. It can be both counter-productive and costly for your practice, not to mention, they can end up getting you into trouble. Too many errors can result in the imposition of program integrity actions by the Medicare administrative contractor against […]
Claim Denial Denial of a claim is the refusal of an insurance company or carrier to honor a request by an individual, or his or her provider, to pay for health care services obtained from a health care professional. Many practices do not make the effort to appeal denied claims. As per AMA, the most […]
Why I am getting CO 4 Denial? CO 4 Denial Code: The procedure code is inconsistent with the modifier used or a required modifier is missing. You are receiving this reason code when a claim is submitted and the procedure code(s) are billed with the wrong modifier(s), or the required modifier(s) are missing. A clear […]
CO/PR 96: Non-covered charges At least one of Remark Code for CO 96 denial code must be provided: N425: Statutorily excluded N180 or N56: It indicates wrong Dx code was used on the claim for the CPT code Billed N115: It indicates that the claim was denied based on the LCD submitted M114: The Beneficiary […]
Basics of Denial Code CO 109 Denial Code CO 109 – Claim or Service not covered by this payer or contractor. You must send the claim/service to the correct payer/contractor. Denial Code CO 109 tells you that you might have a coordination of benefits (COB) issues to resolve. If you are getting a lot of […]
Basics of CO 197 CO 197 Denial Code: Precertification/authorization/notification absent. Some of the insurance companies request to obtaining prior authorization from them before the service/surgery. This may be required for certain specific procedures or may even be for all procedures. So, these are carrier-specific and procedure-specific. Please note that it is the responsibility of the […]
What are Medicare Denial Codes? Medicare denial codes are standard messages used to provide or describe the information to a medical patient or provider by insurances about why a claim was denied. This is the standard format followed by all insurances for relieving the burden on the medical provider. MACs use appropriate group, claim adjustment […]
Basics of CO 45 Denial code CO 45: Charges exceed your contracted/legislated fee arrangement. Kindly note this adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. What is a Denial Code? Denial reason codes are […]
