List of Frequently Seen Denial Codes

The table below lists the most frequently received claim denial codes and what you can do to resolve the claim.

Denial
Code

Description What You Can Do
4 The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Remove the modifier from the claim and resubmit or appeal the claim, depending on the payer's requirements.
15 The authorization number is missing, invalid, or does not apply to the billed services or provider. Add the authorization number and resubmit the claim.
16 Claim/service lacks information which is needed for adjudication. 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.) Refer to the EOB/ERA to determine what is missing, then make the necessary correction and resubmit or appeal the claim, depending on payer requirements.
17 Requested information was not provided or was insufficient or incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code. Contact the payer to determine what information was requested and submit the information to the payer.
18 Duplicate claim or service. Verify it was truly a duplicate claim. If it was not a duplicate claim, contact the payer to find out how they processed the original claim.
19 This is a work-related injury or illness and thus the liability of the Worker's Compensation Carrier. Update the patient's payer mix and resubmit the claim(s) to the correct payer.
20 This injury or illness is covered by the liability carrier. Update the patient's payer mix and resubmit the claim(s) to the correct payer.
21 This injury or illness is the liability of the no-fault carrier. Update the patient's payer mix and resubmit the claim(s) to the correct payer.
22 This care may be covered by another payer per coordination of benefits. Update the patient's payer mix and resubmit the claim(s) to the correct payer.
26 Expenses incurred prior to coverage. Update the patient's payer mix and resubmit the claim(s) to the correct payer, or pass claim(s) to patient responsibility.
27 Expenses incurred after coverage terminated. Update the patients payer mix and resubmit the claim(s) to the correct payer, or pass claim(s) to patient responsibility.
28 Coverage not in effect at the time the service was provided. Notes: Redundant to codes 26 and 27. Update the patients payer mix and resubmit the claim(s) to the correct payer, or pass claim(s) to patient responsibility.
29 The time limit for filing has expired. If the denial is not valid appeal to the payer or if it is valid write the charge off.
31 Patient cannot be identified as our insured. Update the patient's payer information and resubmit the claim.
50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Appeal the claim if appropriate, write off the charge, or bill the patient based on the payer requirements.
57 Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. Notes: Split into codes 150, 151, 152, 153 and 154. Appeal the claim if appropriate, write off the charge, or bill the patient based on the payer requirements.
96 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.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Appeal the claim if appropriate, write off the charge, or bill patient based on the payer requirements.
100 Payment made to patient/insured/responsible party/employer. Post the denial and then pass line items to patient responsibility.
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. Update the patient's payer mix and resubmit the claim(s) to the correct payer.
119 Benefit maximum for this time period or occurrence has been reached. Appeal if appropriate, or pass to patient or next payer.
140 Patient/Insured health identification number and name do not match. Review a copy of insurance card and update patients name and ID number accordingly and resubmit the claim.
151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. Appeal or write off the charge.
165 Referral absent or exceeded. Attach the referral and resubmit if appropriate.
182 Procedure modifier was invalid on the date of service. Add/change the appropriate modifier and resubmit or appeal the claim based on the payer's requirements.
198 Precertification/authorization/notification absent. Attach the authorization and resubmit or appeal the claim based on payer's requirements.
198 Precertification/authorization exceeded. Attach updated authorization and resubmit or appeal based on payer's requirements.
226 Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. 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.) Contact the payer to determine what information is missing and provide that information to payer, either by contacting payer or resubmitting claim(s).
227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. 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.) Pass the line item(s) to patient so that they will get a patient statement, call the payer to find out what information was requested and call patient.
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