CO 6 Denial Code: The procedure/revenue code is inconsistent with the patient's age
When the claim says CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, it means claim denied as the CPT code or revenue code billed is not compatible with patient age.
Let us...
Denial Code CO 204 - Not Covered under the Patient's current benefits plan
With a valid Advance Beneficiary Notice (ABN):
PR-204: This service, equipment and/or drug is not covered under the patient's current benefit plan
PR-N130: Consult plan benefit documents/guidelines for information about restrictions for this service
Without a valid ABN:
...
(MEDICARE DOES NOT PAY FOR THIS MANY SERVICES OR SUPPLIES)
CO -119 Benefit maximum for this time period or occurrence has been reached.
Check Benefit Information through website/Calls
If NO - Call the carrier and send the claim back to reprocess.
PR - 119 Benefit maximum for this time period or occurrence has...
Insurance denial CO 39: Services denied at the time Prior authorization/pre-certification was requested
Some carriers insist on obtaining prior authorization from them before the surgery. This may be for certain specific procedures or may even be for all procedures. So these are carrier specific and procedure specific.
Please note that it...
Denial Code CO 47: Diagnosis Missing or Invalid
Insurances Company will be denying the claim with CO 47 Denial Code: This (these) diagnosis (es) is (are) not covered, missing, or are invalid, whenever the Diagnosis CPT code is not Valid or missing.
Diagnosis Code is Invalid
The payer is indicating that one...
Insurance Denial CO 38: Services Not Authorized by Providers
There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. A failed authorization can result in a requested service being denied or in an...
DENIAL CODE CO-10: The diagnosis code is inconsistent with the patient’s gender
Insurance will deny the claim with CO-10 denial code – The diagnosis code is inconsistent with the patient’s gender, when the diagnosis code is not compatible with the patient’s age.
Let us consider the below examples to understand CO-10...
Healthcare providers sometimes offer "prompt-pay discount" to encourage patients to pay their bills within a certain period, including outstanding copayments or deductible amounts. Such programs should be structured appropriately to ensure compliance with applicable laws and payer contracts.
The legal rules differ by state.
California law, for example, allows healthcare providers...
Denial Code CO 11 – The diagnosis is inconsistent with the procedure
Insurance will deny the claim as Denial Code CO 11. Whenever the Procedure code billed with an inappropriate diagnosis code.
Diagnosis code (DX Code):
Diagnosis code represents the description of the disease. These codes are assigned by medical coding department...
CO12 Denial Code: Diagnosis is inconsistent with the Provider Type
Insurance will deny the claim as Adjustment Code CO 12 – The diagnosis is inconsistent with the provider type, whenever the Procedure code billed with an inappropriate diagnosis code.
Diagnosis code (DX Code):
Diagnosis code represents the description of the disease. These codes...