You may also receive a Remittance Advice Remark Codes (RARC) N127. This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them. Reason For Denials CO 22, PR 22 & CO 19 Medicare may not be a Primary payer for the services/procedures rendered on a particular service…
CO 146 means that the insurance company has denied the claim because the diagnosis code(s) provided on the claim form does not support the medical necessity of the service(s) rendered. The description of CO 146 is “Payment denied due to the diagnosis code(s) reported on the claim.” Common Reasons for Denial CO 146 Next Steps…
CO 131 that the submitted diagnosis code(s) does not support the medical necessity of the procedure performed, leading to the denial of the claim. The official description of the denial code CO 11 is: “The diagnosis is inconsistent with the procedure.” Common Reasons for the Denial CO 131 There are several common reasons for the…
CP13 means that the claim submitted for payment has a date of service that is after the patient’s recorded date of death. As a result, the claim is denied by the insurance company. Description: The denial code CO 13 refers to “The date of death precedes the date of service.” Common Reasons for the Denial…
CO 129 indicates that the submitted claim contains a procedure modifier that is not appropriate for the date of service for a new patient. Description: Denial code CO 129 refers to “New patient procedure modifier is invalid for the date of service.” Common Reasons for Denial CO 129 Next Steps How to Avoid Denial CO…
Denial code CO 119 refers to a situation when a healthcare claim is denied due to a benefit maximum for the patient’s policy being reached. In other words, the insurance company has determined that the patient has already received the maximum allowed benefits for the specific service, and any additional services will not be covered…
Description: The Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) indicates that the claim has been denied due to “The diagnosis is inconsistent with the procedure.” Common Reasons for the Denial CO 11: Next Steps:
Denial code CO 109 refers to a claim denied due to the services or procedures not being considered medically necessary according to the payer’s policies and guidelines. This means the insurance company does not believe that the treatment or service provided was essential for the patient’s health and well-being. Description of denial code CO 109…
Description: Denial code CO 107 refers to “The related or qualifying claim/service was not identified on this claim.” This means that the submitted claim is missing information about a related or qualifying service necessary for proper adjudication. Common Reasons for the Denial CO 107: Next Steps: How to Avoid Denial CO 107 in the Future:
