Denial code 54

Denial code 1 is for Deductible Amount. It means the patient needs to pay a certain amount before insurance coverage kicks in.

Denial code 10 means the diagnosis doesn't match the patient's gender. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 100 is when the payment is made directly to the patient, insured, or responsible party instead of the healthcare provider.

Denial code 101 is for predetermination, which means the payment is expected after services or claim processing.

Denial code 102 is a Major Medical Adjustment that indicates a claim has been denied or adjusted due to a significant medical reason.

Denial code 103 is when a healthcare provider's promotional discount, like a senior citizen discount, is not accepted by the insurance company.

Denial code 104 is when a managed care organization withholds payment for a healthcare service.

Denial code 105 is for tax withholding. Learn why this code may be affecting your healthcare revenue cycle management.

Denial code 106 is when the patient's chosen payment option is not in effect.

Denial code 107 means the claim doesn't have the necessary information to link it to the related service. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 108 means the guidelines for renting or purchasing were not followed. Check the 835 Healthcare Policy Identification Segment for more information.

Denial code 109 is when the claim or service is not covered by the payer/contractor. You need to send it to the right one.

Denial code 11 means the diagnosis doesn't match the procedure. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 110 is when the billing date is before the service date.

Denial code 111 is when a service is not covered unless the provider accepts assignment.

Denial code 112 is when the service was not provided directly to the patient and/or not properly documented.

Denial code 114 is when a procedure or product is not approved by the FDA.

Denial code 115 means that a medical procedure was postponed, canceled, or delayed. Find out why and how to resolve it for proper reimbursement.

Denial code 116 is when the patient's advance indemnification notice doesn't meet the necessary requirements.

Denial code 117 means transportation is only covered to the closest facility that can provide the necessary care.

Denial code 118 is for ESRD network support adjustment. Learn why your healthcare provider may have received this denial code and how to address it.

Denial code 119 means the maximum benefit for this time period or occurrence has been reached.

Denial code 12 means the diagnosis doesn't match the provider type. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 121 is an adjustment made to compensate for any outstanding member responsibility in healthcare billing.

Denial code 122 is a reduction in payment for psychiatric services. Understand why this code is important for healthcare providers and how to address it.

Denial code 128: Newborn's services are covered in the mother's Allowance.

Denial code 129 is when there is incorrect prior processing information. At least one Remark Code must be provided.

Denial code 13 means the date of death comes before the date of service.

Denial code 130 is for claim submission fee. Learn why your healthcare provider may receive this denial code and how to avoid it.

Denial code 131 is when a claim is denied because it includes a negotiated discount that is specific to that claim.

Denial code 132 is a prearranged demonstration project adjustment that may affect healthcare provider's revenue cycle management.

Denial code 133 is a temporary status for a healthcare service that is under review. It requires correction once the review is complete.

Denial code 134 is when technical fees are taken out from the charges.

Denial code 135 is when interim bills cannot be processed.

Denial code 136 is for failure to follow prior payer's coverage rules. It is used with Group Code OA.

Denial code 137 is for regulatory surcharges, assessments, allowances, or health-related taxes that were not approved for reimbursement.

Denial code 139 is for a contracted funding agreement where the subscriber is employed by the provider of services. Use with Group Code CO.

Denial code 14 means the patient's date of birth is after the date of service.

Denial code 140 is when the patient's or insured's health identification number and name do not match.

Denial code 142 is for the monthly Medicaid patient liability amount.

Denial code 143 is when a portion of the payment is deferred, meaning it is not immediately approved or paid by the insurance company.

Denial code 144 is an incentive adjustment, like a preferred product or service, that has been denied for reimbursement.

Denial code 146 means the diagnosis reported for the service date(s) was not valid.

Denial code 147 is when the provider's negotiated rate has expired or is not on file.

Denial code 148 means that the information from another provider was not given or was incomplete. At least one remark code must be provided.

Denial code 149: Lifetime benefit max reached for this service/benefit category. Understand why your healthcare claim was denied.

Denial code 150 is when the payer believes the information provided does not justify the level of service.

Denial code 151 is when the payer believes that the information provided does not justify the number or frequency of services.

Denial code 152 means the payer doesn't think the information provided justifies the length of service. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 153 is when the payer believes that the information provided does not justify the prescribed dosage.

Denial code 154 is when the payer determines that the information provided does not justify the amount of medication or supplies for that day.

Denial code 155 is when the patient refuses the service or procedure.

Denial code 157 is when a service or procedure is denied because it was provided due to an act of war.

Denial code 158 is when the service/procedure was provided outside of the United States.

Denial code X is "Service/procedure provided due to terrorism." Understand why healthcare providers may face denials related to this unique circumstance.

Denial code 16 is for claims with missing or incorrect information. A remark code must be provided. Do not use for attachments or documentation.

Denial code X is for injuries/illnesses caused by activities not covered by insurance.

Denial code 161 is a provider performance bonus that has been denied for reimbursement.

Denial code 163 means that the requested documents for the claim were not received.

Denial code 164 is when the required documents for a claim were not received on time.

Denial code 166 is when services are submitted after the payer's responsibility for processing claims under the plan has ended.

Denial code 167 means the diagnosis is not covered. Check the 835 Healthcare Policy Identification Segment for more information.

Denial code 169: Alternate benefit has been provided. Understand why your healthcare claim was denied and how to resolve it.

Denial code 170 means payment is denied for services provided by this type of provider. Refer to the 835 Healthcare Policy Identification Segment for more information.

Denial code 171 means payment is denied for services provided by a specific type of provider in a specific type of facility. Check the 835 Healthcare Policy Identification Segment for more information.

Denial code 172 means payment is adjusted for services performed by a provider of a specific specialty. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 173 is when a physician did not prescribe the service or equipment.

Denial code 174 is when the service was not prescribed before it was delivered.

Denial code 175 is for an incomplete prescription.

Denial code 176: Prescription is not current. Understand why healthcare providers may face this issue and how to address it effectively.

Denial code 177: Patient has not met the required eligibility requirements. Simplify your healthcare revenue cycle management with our expert guidance.

Denial code 178: Patient has not met spend down requirements. Understand why insurance claims are denied & how to resolve them. Expert healthcare revenue cycle management advice.

Denial code 179 means the patient hasn't fulfilled the waiting requirements. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 18 is for an exact duplicate claim or service. It is used with Group Code OA, except in cases where state workers' compensation regulations require CO.

Denial code 180 is when the patient does not meet the necessary residency requirements.

Denial code 181 is when the procedure code used was not valid on the date of service.

Denial code 182 is when the procedure modifier used on the date of service is not valid.

Denial code 183 means the referring provider is not authorized to refer the service billed. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 184 means the provider is not authorized to prescribe the service. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 185 means the provider is not allowed to perform the service billed. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 186 is a level of care change adjustment that may result in a claim being denied by insurance companies.

Denial code 187 is for Consumer Spending Account payments, like Flexible Spending Account or Health Savings Account, that were not approved.

Denial code 188 is when a product or procedure is not covered unless it is used as recommended by the FDA.

Denial code 189 means a procedure code was billed that doesn't have a specific code for that service.

Denial code 19 is when the insurance company denies payment because they believe the injury or illness is related to work and should be covered by Worker's Compensation.

Denial code 190 means payment is already covered for a qualified stay at a Skilled Nursing Facility (SNF).

Denial code 192 is a non-standard adjustment code used by providers/payers to provide Coordination of Benefits information to another payer. It is used when the non-standard code cannot be mapped to an existing Claims Adjustment Reason Code for Deductible, Coinsurance, and Co-payment.

Denial code 193 is when the original payment decision is being maintained because the claim was processed correctly.

Denial code 194 is for anesthesia performed by the operating physician, assistant surgeon, or attending physician.

Denial code 195 is when a refund is mistakenly given to the wrong payer for a claim or service.

Denial code 197 is when precertification/authorization/notification/pre-treatment is missing.

Denial code 198 is when the precertification, notification, authorization, or pre-treatment requirements have been exceeded.

Denial code 199 is when the revenue code and procedure code don't match, causing a claim to be rejected by the insurance company.

Denial code 2 is for coinsurance amount. It refers to the portion of the medical bill that the patient is responsible for paying after their insurance has paid its share.

Denial code 20: Injury/illness covered by liability carrier. Understand why your healthcare claim was denied.

Denial code 200 is when expenses are not covered due to a lapse in insurance coverage.

Denial code 201 means the patient is responsible for the claim amount due to an agreement. A remark code must be provided. #healthcarerevenue #denialcode

Denial code 202 is for services that are not covered by insurance, such as personal comfort or convenience services.

Denial code 203 is when a healthcare provider's claim is rejected because the service was discontinued or reduced.

Denial code 204 is when a service, equipment, or drug is not covered by the patient's insurance plan.