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INSURANCE DENIALS

Learn what are different types of Insurance denials and why Insurance may deny the claims and how to handle denials in medical billing.

Denial Code CO 47: Diagnosis Missing or Invalid

Denial Code CO 47: Diagnosis Missing or Invalid

  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,...
Insurance Denial CO 38: Services Not Authorized by Providers

Insurance Denial CO 38: Services Not Authorized by Providers

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...
CO-10 Denial Code: Diagnosis Code is Inconsistent with the Patient's gender

CO-10 Denial Code: Diagnosis Code is Inconsistent with the Patient’s gender

  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...
What is Prompt-pay Discount? Adjustment Code CO-44.

What is Prompt-pay Discount? Adjustment Code CO-44.

  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...
Denial CO 11: Diagnosis is inconsistent with The Procedure

Denial CO 11: Diagnosis is inconsistent with The Procedure

  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...
CO12 Denial Code: Diagnosis is inconsistent with the Provider Type

CO12 Denial Code: Diagnosis is inconsistent with the Provider Type

  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...
Adjustment Code 61: Penalty for failure to obtain second surgical opinion

Adjustment Code 61: Penalty for failure to obtain second surgical opinion

  Most health insurance plans will pay for a second surgical opinion, but be sure to contact your plan beforehand to find out for sure. In some cases, if you don't get...
Complete Medicare Denial Codes List - Updated

Complete Medicare Denial Codes List – Updated

  Medicare denial codes provide or describe the standard information to a patient or provider by an insurances about why a claim was denied. This is the standard format followed by all...
CO 40: What is emergent/urgent care? And why insurance denied claim?

CO 40 Denial Code: Why Insurance deny Emergency Room claims?

What is the Difference between Urgent Care and Emergency Room? Urgent care can treat minor fractures, nonemergency x-rays, back pain, and cold and flu symptoms. At the same time, the emergency room...
Insurance Denial Code CO 64: Denial Reversed per Medical Review

Insurance Denial Code CO 64: Denial Reversed per Medical Review

  Understand Insurance Denial Code CO 64: Denial Reversed per Medical Review Reversed Claim means a Claim that initially is paid but a subsequent Claim with the same Pharmacy, Covered Individual, prescription number,...