Denial code 12

Denial code 205 is for the pharmacy discount card processing fee.

Denial code 206 is when the National Provider Identifier (NPI) is missing, which can result in a claim being denied by insurance companies.

Denial code 207 is for an invalid format of the National Provider Identifier (NPI).

Denial code 208 is when the National Provider Identifier (NPI) does not match.

Denial code 209 is when the provider cannot collect a certain amount from the patient due to regulatory or other agreements. However, this amount can be billed to another payer. If collected, it must be refunded to the patient. (Use with Group code OA)

Denial code 21: The no-fault carrier is responsible for this injury/illness.

Denial code 210 means payment was adjusted because pre-certification/authorization was not received on time.

Denial code 211: NDCs not eligible for rebate, not covered. Understand why your healthcare provider may receive this code and how to address it.

Denial code 212: Administrative surcharges are not covered. Understand why your healthcare claim was denied and how to address it.

Denial code 213 is when a healthcare provider does not follow the rules about referring patients to other doctors or facilities, according to the law or the insurance company's policy.

Denial code 215 is when a claim is denied because it is based on the subrogation of a third party settlement.

Denial code 216 is issued when a review organization determines that the claim does not meet the necessary requirements for reimbursement.

Denial code 219 is based on the extent of injury. Providers should refer to the insurance policy number or healthcare policy identification for jurisdictional regulations.

Denial code 22 is when the healthcare service may be covered by another insurance provider due to coordination of benefits.

Denial code 222 means the provider has exceeded the agreed limit for hours/days/units. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 223 is for a mandated law or regulation that is not covered by another code and must be followed before a new code can be created.

Denial code 224 is when a patient's identity is stolen, and additional verification is needed to process their claims.

Denial code 225 is for penalty or interest payment by payer, used for plan to plan encounter reporting within the 837.

Denial code 226 means the billing or rendering provider did not provide requested information on time or it was incomplete. A Remark Code is needed.

Denial code 227 means the patient or responsible party did not provide enough or complete information. A Remark Code is needed to explain the reason for denial.

Denial code 228 is when a claim is denied because the provider, another provider, or the subscriber did not provide the necessary information to a previous payer for review.

Denial code 229 is when Medicare doesn't consider a partial charge due to the claim type. It's used to convey coordination of benefits info in the 837 transaction. (Use with Group Code PR)

Denial code 23 is used when a prior payer's decision affects the payment or adjustments made. (Group Code OA)

Denial code 231 means that certain procedures cannot be performed on the same day or in the same setting. Check the 835 Healthcare Policy Identification Segment for more information.

Denial code 232 explains the difference in DRG amount when a patient's care involves multiple institutions. Applies to institutional claims only.

Denial code 233 is for services/charges related to hospital-acquired conditions or preventable medical errors.

Denial code 234 is when a procedure is not paid separately. At least one Remark Code must be provided.

Denial code 235 is for sales tax. It indicates that the claim was denied due to issues related to sales tax calculations or documentation.

Denial code 236 means that a procedure or combination of procedures is not compatible with another procedure or combination provided on the same day, as per coding guidelines or workers compensation regulations/fee schedules.

Denial code 237 is a Legislated/Regulatory Penalty. It means that there must be at least one Remark Code provided, which can be either the NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT.

Denial code 238 is for claims that cover both eligible and ineligible periods of coverage. It indicates a reduction for the ineligible period and is used with Group Code PR.

Denial code 239 means the claim covers both eligible and ineligible periods. Separate claims need to be rebilled.

Denial code 24 means charges are covered under a capitation agreement/managed care plan.

Denial code 240 means the diagnosis doesn't match the patient's birth weight. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 241 is for the Low Income Subsidy (LIS) co-payment amount in healthcare billing.

Denial code 242 means services were not provided by network or primary care providers. Learn how to handle this common billing issue.

Denial code 243 means services were not approved by your network or primary care providers. Learn how to resolve this issue and get your claims paid.

Denial code 245 is a provider performance program withhold that affects healthcare revenue cycle management.

Denial code 246 is a non-payable code used for reporting purposes only.

Denial code 247 is when the deductible for a professional service is billed on an institutional claim in a healthcare setting.

Denial code 248 is when there is a coinsurance issue for a professional service provided in a hospital or institutional setting and billed on an institutional claim.

Denial code 249 is for claims identified as readmissions. (Use with Group Code CO)

Denial code 250 is when the incorrect attachment/document was received or the expected attachment/document is still missing. A Remark Code must be provided.

Denial code 251 means the documentation received was incomplete. More information is needed to process the claim.

Denial code 252: An attachment is needed to process this claim. Provide a Remark Code (NCPDP Reject Reason Code or Remittance Advice Remark Code) that is not an ALERT.

Denial code 253 is a reduction in federal payment known as sequestration.

Denial code 254 is when the dental plan received the claim, but the benefits are not covered. Submit these services to the patient's medical plan for further consideration.

Denial code 256 is when a healthcare provider's service is not covered by a managed care contract, resulting in non-payment.

Denial code 257 is when a claim or service is not determined during the grace period for premium payment. It will be corrected once the grace period ends. #healthcarerevenuecycle #denialcode

Denial code 258 is when a claim or service is not covered because the patient is in custody or incarcerated. The claim/service may be covered by a relevant authority.

Denial code 259 is for additional payment denial for Dental/Vision service utilization.

Denial code 26 is when expenses are incurred before insurance coverage starts.

Denial code 260 is when a claim is processed under the Medicaid ACA Enhanced Fee Schedule and is not approved for payment.

Denial code 261 means the procedure or service doesn't match the patient's medical history.

Denial code 262 is an adjustment for delivery cost. It is used specifically for pharmaceuticals.

Denial code 263 is an adjustment for shipping cost. It is used specifically for pharmaceuticals.

Denial code 264 is an adjustment for postage cost. It is used specifically for pharmaceuticals.

Denial code 265 is an adjustment for administrative cost. It is used specifically for pharmaceuticals.

Denial code 266 is an adjustment for the cost of compound preparations in healthcare billing. It is specifically used for pharmaceuticals.

Denial code 267 is for claims that span multiple months. It requires at least one Remark Code to be provided, which can be either an NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT.

Denial code 268 is when a claim spans two calendar years. Resubmit one claim per calendar year.

Denial code 269 means anesthesia is not covered for this service/procedure. Refer to the 835 Healthcare Policy Identification Segment for more information.

Denial code 27 is when expenses are incurred after coverage has ended, resulting in a claim denial.

Denial code 270 is when the medical plan received the claim, but the benefits are not covered. You should submit these services to the patient's dental plan for further consideration.

Denial code 271 is for prior contractual reductions on a current payment schedule when deferred amounts were already reported. (Use with Group Code OA)

Denial code 272 is when the healthcare provider's services did not meet the coverage or program guidelines.

Denial code 273 is when the healthcare provider exceeded the coverage or program guidelines, resulting in the claim being denied.

Denial code 274 is when a healthcare provider's fee/service is not payable due to a patient care coordination arrangement.

Denial code 275 is when the prior payer does not cover the patient's responsibility, like deductibles or co-payments. (Use with Group Code PR)

Denial code 276 means that the services rejected by the previous payer are not covered by the current payer.

Denial code 277 is when a claim or service is not determined during the premium payment grace period. It will be reversed and corrected once the grace period ends. #healthcarerevenuecyclemanagement #denialcodes

Denial code 278 is when the performance program requirements are not met. Refer to the 835 Healthcare Policy Identification Segment for more information.

Denial code 279 is for services not provided by Preferred network providers. It's used when there are limitations on using contracted providers outside of the member's network.

Denial code 280 is when the medical plan received the claim, but the benefits are not covered. Submit the services to the patient's Pharmacy plan for further consideration.

Denial code 281 is for when the deductible is waived as per the contractual agreement. Use it only with Group Code CO.

Denial code 282 means the procedure or revenue code doesn't match the type of bill. Check the 835 Healthcare Policy Identification Segment for more information.

Denial code 283: Attending provider not eligible to direct care. Understand why your claim was denied and how to resolve it.

Denial code 284: Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services.

Denial code 285 is when appeal procedures are not followed. Learn why this code may impact healthcare providers' revenue cycle management.

Denial code 286 is when the appeal time limits for a healthcare claim are not met. Learn how to handle this common issue in healthcare revenue cycle management.

Denial code 287 means the referral for healthcare services has exceeded the allowed limit.

Denial code 288 is when a referral is missing or not provided, resulting in a claim denial.

Denial code 289 is when services are not covered by dental and medical plans, so benefits are not available.

Denial code 29 means the healthcare provider missed the deadline for submitting a claim.

Denial code 290 is when the dental plan does not cover the benefits claimed. The claim is then sent to the patient's medical plan for review.

Denial code 291 means the medical plan does not cover the benefits claimed. The claim has been sent to the patient's dental plan for review.

Denial code 292 is when the medical plan does not cover the benefits for the claim. The claim is then sent to the patient's pharmacy plan for review.

Denial code 293 is when the payment is made to the employer instead of the healthcare provider.

Denial code 294 is when a payment is made directly to an attorney instead of the healthcare provider.

Denial code 295 is related to Pharmacy Direct/Indirect Remuneration (DIR) in healthcare revenue cycle management (RCM).

Denial code 296 is when the precertification/authorization/notification/pre-treatment number is valid but doesn't apply to the provider.

Denial code 297 is when the medical plan received the claim, but the benefits are not covered. Submit the services to the patient's vision plan for further consideration.

Denial code 298 is when the medical plan received the claim, but the benefits are not covered under this plan. The claim has been sent to the patient's vision plan for review.

Denial code 299 means the billing provider cannot get paid for the service they billed.

Denial code 3 is for co-payment amount. It indicates that the patient's insurance claim was denied due to an unpaid or incorrect co-payment.

Denial code 300 means the claim was received by the Medical Plan, but benefits are not available. It has been forwarded to the patient's Behavioral Health Plan for further review.

Denial code 301 means the claim was received by the Medical Plan, but the benefits are not covered. Submit the services to the patient's Behavioral Health Plan for further consideration.

Denial code 302 means that the time limit for obtaining pre-approval or authorization for a medical treatment has expired.

Denial code 303 is when the prior payer does not cover the patient's responsibility (deductible, coinsurance, co-payment) for Qualified Medicare and Medicaid Beneficiaries.

Denial code 304 means the medical plan received the claim, but the benefits are not covered. Submit these services to the patient's hearing plan for further consideration.