Home REVENUE CYCLE MANAGEMENT INSURANCE DENIALS

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.

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 a second opinion for a procedure, you may have to pay a higher percentage of the cost. When your...
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 code (DX Code): Diagnosis code represents the description of the disease. These codes are assigned by medical coding department...
What is Denial Reason Code CO 22? How to Resolve it?
  Denial Code CO 22 - This care may be covered by another payer per coordination of benefits (COB). Coordination of Benefits is also called as COB. If patient has more than one payer, then the Coordination of Benefits rules determines and decides which will be the primary, then secondary and...
Authorization number is Missing or Invalid - Denial Code CO-15
  Denial Code CO-15 – The authorization number is missing, invalid, or does not apply to the billed services or provider If the services billed require authorization, then insurance will deny the claim with denial code CO-15 , if the claim submitted is invalid or incorrect or with no authorization number. First...
CO 40: What is emergent/urgent care? And why insurance denied claim?
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 may treat more severe conditions, such as chest pain, heart attack symptoms, and difficulty breathing. Whether you go to urgent...
Non Covered Services Denial Code CO 46
  What do you do when you are presented with a patient who needs treatment but The patient’s insurance company will not pay for the services? Can you provide the services anyway? Who will pay for them? How do you collect payment for such services? If the patient consents to receive...
Expenses Incurred Prior to Coverage PR 26 Denial Code
  Payers will deny the claims with CO 26 Denial Code – Expenses incurred prior to coverage, whenever the providers perform health care services to patient prior to the insurance coverage starts. What steps needs to be taken? Review other claims in the application within a span of 30 days, to see...
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 insurance companies for relieving the burden on the medical providers. MACs (Medicare Administrative Contractors) use appropriate group, claim...
Decoding Common Denials: Denial Code CO-97
  CO 97 – The benefit for this service is included in the payment or allowance for another service or procedure that has already been Insurances will deny the procedure code as CO 97. Basically, the procedure or service is not paid for separately. This may involve a procedure code that’s inclusive...
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 checking for drug interactions. A failed authorization can result in a requested service being denied or in an...