S No Denial Reason

1 Deductible Amount
2 Co-Insurance Amount
3 Co-Payment

4 Claim/service lacks information or has submission/billing error(s)

5 Exact duplicate claim/service

6 This care may be covered by another payer per coordination of benefits

7 The impact of prior payer(s) adjudication including payments and/or adjustment

8 Charges are covered under a capitation agreement/managed care plan

9 Expenses/Services incurred prior to coverage.

10 Expenses incurred after coverage terminated

11 The time limit for filing has expired / Untimely Filing

12 Patient cannot be identified as our insured

Charge exceeds fee schedule/maximum allowable or contracted/legislated fee

13
arrangement

This is a non-covered service because it is a routine/preventive exam or a

14
diagnostic/screening procedure done in conjunction with a routine/preventive exam
 These are non-covered services because this is not deemed a 'medical necessity' by the
15
payer

16 Non-Covered Charges

The benefit for this service is included in the payment/allowance for another
17
service/procedure that has already been adjudicated

18 Payment made to Patient/Insured/Responsible party

Claim/service not covered by this payer/contractor. You must send the claim/service to
19
the correct payer/contractor

20 Benefit Maximum for this time period or occurrence has been reached

21 Patient/Insured health identification number and name do not match

22 Precertification/Authorization/Notification/Pre-treatment absent

23 This procedure is not paid separately

Services not provided by network/primary care providers / Claim denied as non covered
24
charges as provider is out of network

Secondary payment cannot be considered without the identity of or payment information

25 from the primary payer. The information was either not reported or was illegible / Claim
denied for primary EOB.

This provider was not certified/eligible to be paid for this procedure/service on this date
26
of service

27 Patient is enrolled in a Hospice

28 Missing/incomplete/invalid CLIA certification number

 Denial occurred
CARC Codes (Claim RARC Codes
due to
adjustment reason (Remittance advice Type Responsibility
missing/incomple
codes) remark codes)
te/invalid info
PR-1 Processed Claim - Payment posting
PR-2 Processed Claim - Payment posting
PR-3 Processed Claim - Payment posting

General Denial &

we need to check
Denial
RARC code on
CO-16 Denied Claim Management / AR
EOB when the
processing
claim gets denied
with this reason

Denial
CO-18 Denied Claim General Management / AR
processing

Improper / Lack Denial

CO-22 Denied Claim of insurance Management / AR
verification processing

Denial
CO-23 Denied Claim COB team Management / AR
processing

Improper / Lack Denial

CO-24 Denied Claim of insurance Management / AR
verification processing

Improper / Lack Denial

CO-26 / PR-26 Denied Claim of insurance Management / AR
verification processing

Improper / Lack Denial

CO-27 / PR-27 Denied Claim of insurance Management / AR
verification processing

Denial
CO-29 Denied Claim Billing Management / AR
processing

Improper / Lack Denial

CO-31 Denied Claim of insurance Management / AR
verification processing

CO-45 Processed Claim Payments Team Payment posting

Denial
CO-49 Denied Claim Coding Management / AR
processing
 Denial
CO-50 Denied Claim Coding Management / AR
processing

Denial
CO-96 Denied Claim Coding Management / AR
processing

Denial
CO-97 Denied Claim Coding Management / AR
processing
Billing & Payment posting /
PR-100 Processed Claim
Payments Team Patient billing
Improper / Lack Denial
CO-109 Denied Claim of insurance Management / AR
verification processing

Improper / Lack Denial

CO-119 Denied Claim of insurance Management / AR
verification processing

Improper / Lack Denial

CO-140 Denied Claim of insurance Management / AR
verification processing

Denial
CO-197 Denied Claim Coding Management / AR
processing

Denial
CO-234 Denied Claim Coding Management / AR
processing

Denial
Provider
CO-243 & CO-242 Denied Claim Management / AR
Enrollment
processing

Denial
CO-22 with MA04 Denied Claim COB team Management / AR
processing

Denial
Provider
CO-B7 Denied Claim Management / AR
Enrollment
processing

Denial
CO-B9 Denied Claim Coding Management / AR
processing

Denial
CO-16 with MA120 Denied Claim Coding Management / AR
processing