DENIAL CODES

CONTRACTUAL

100

CLAIM/SERVICE LACKS INFORMATION OR HAS SUBMISISON/BILLING ERRORS

CO16

200

EXACT DUPLICATE CLAIM/SERVICE

CO18

300

THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS

WHAT IS DENIAL CODE 22

400

THE IMPACT OF PRIOR PAYER(S) ADJUDICATION  INCLUDING PAYMETNS AND/OR ADJUSTMENTS

WHAT IS OA23

500

TIMELY FILING FOR FILING HAS EXPIRED

WHAT IS DENIAL CODE 29

PATIENT RESPONSIBILITY

100

EXPENSES INCURED AFTER COVERAGE TERMINATION

PR27

200

EXPENSES INCURRED PRIOR TO COVERAGE

PR26

300

PATIENT CAN NOT BE IDENTIFIED AS THE INSURED

PR31

400

LIFETIME BENEFITS HAS BEEN REACHED 

PR35

NON COVERED

100

CHARGES EXCEED FEE SCHEDULE/MAX ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT

CO45

200

This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam

PR49

300

These are non-covered services because this is not deemed a 'medical necessity' by the payer.

CO50

400

Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CO96

500

The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

CO97

Denials

100

Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CO129

200

Diagnosis was invalid for the date(s) of service reported.

Denial code 146

300

Payer deems the information submitted does not support this level of service.

DENIAL CODE 150

400

Procedure modifier was invalid on the date of service.

182

500

Precertification/authorization/notification/pre-treatment absent.

CO197

RANDOM

100

National Provider Identifier - missing.

206

200

National Provider Identifier - Not matched.

208

300

This non-payable code is for required reporting only.

246

400

The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

251

500

Sequestration - reduction in federal payment

253