Denial Codes – Healthcare

CO 45 Denial Code – Charges exceed the fee schedule/maximum allowable or contracted/legislated fee arrangement. This CO 45 Denial code

Insurance deny the claim with CO 97 denial code, when procedure code is inclusive with the other procedure code billed

Whenever claim denied with CO 197 Denial Code – Pre-certification/authorization/notification absent, it means authorization number is missing for the services

Denials Management in Healthcare – Medical Billing: For proper denials management of medical claims in medical billing, first we need

Insurances will deny the claim as Denial Code CO 119 – Benefit maximum for this time period or occurrence has

What is offset in medical billing? When an insurance company makes a wrong or excess payment to its provider, it

CO 31 Denial Code- Patient cannot be identified as our insured: Insurance will deny the claim with CO 31 Denial

CO 26 Denial Code – Expenses incurred prior to coverage: Payers will deny the claims with CO 26 Denial Code

Insurance will deny with CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a

As we know when the claims submitted to secondary insurance for balance, secondary insurance will process and allow the claim

CO 20 Denial Code – This injury/illness is covered by the liability carrier: Insurance will deny the claim with CO

Insurance company will deny the claim with CO 19 denial code – This is a work related injury/illness and thus

Insurance will be denying the claim as CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete,

If the services billed require authorization, then insurance will deny the claim with CO 15 denial code – The authorization

CO 13 Denial Code – The date of death precedes the date of service. Insurance will deny the claim with

CO 9 Denial Code – The diagnosis code is inconsistent with the patient’s age: Insurance will deny the claim with

When the claim denied as CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender means

When the claim says CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, it means

Insurances Company will be denying the claim with CO 5 Denial Code – Procedure code/Bill Type is inconsistent with the

When the insurance process the claim towards PR 1 denial code – Deductible amount, it means they have processed and

Denial Codes in Medical Billing – Lists: CO – Contractual Obligations OA – Other Adjsutments PI – Payer Initiated reductions