Denial code 85

Denial code 305 is when the medical plan received the claim, but the benefits are not covered under this plan. The claim is then sent to the patient's hearing plan for further review.

Denial code 31 means the patient cannot be recognized as our insured.

Denial code 32 means the patient is not eligible as a dependent according to our records.

Denial code 33 means the insured person does not have coverage for dependents.

Denial code 34: Insured has no coverage for newborns. Understand why insurance claims get denied and how to resolve them. Expert healthcare revenue cycle management advice.

Denial code 35: Lifetime benefit maximum has been reached. Understand why your healthcare claim was denied and how to address it.

Denial code 39 means services were denied when authorization/pre-certification was requested.

Denial code 4 means the procedure code doesn't match the modifier used. Check the 835 Healthcare Policy Identification Segment for more information.

Denial code 40 means charges don't qualify as emergent/urgent care. Check the 835 Healthcare Policy Identification Segment for more info.

Denial code 44 is for prompt-pay discount.

Denial code 45 is when the charge for a service exceeds the maximum fee allowed by the payer. This adjustment cannot be the same as previous payments or reductions.

Denial code 49 means the service is not covered because it is a routine/preventive exam or a diagnostic/screening procedure done with a routine/preventive exam. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 5 means the procedure code or type of bill doesn't match the place of service. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 50 means the service is not covered because it's not considered medically necessary by the insurance company. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 51 means the service is not covered due to a pre-existing condition. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 53: Services by a relative or household member not covered. Understand why your healthcare claim was denied.

Denial code 54 means that multiple physicians/assistants are not covered in this case. Refer to the 835 Healthcare Policy Identification Segment for more information.

Denial code 55 means the payer considers the procedure/treatment/drug as experimental/investigational. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 56 means the payer doesn't consider the procedure/treatment effective. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 58 means the treatment was done in the wrong place. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 59 is for claims that were processed based on multiple or concurrent procedure rules. It's important to refer to the 835 Healthcare Policy Identification Segment for more information.

Denial code 6 means the procedure or revenue code doesn't match the patient's age. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 60 means outpatient services aren't covered when done close to inpatient services. #healthcarerevenuecyclemanagement #denialcodes

Denial code 61 is when a claim is rejected because the provider did not obtain a second surgical opinion as required.

Denial code 66 is for Blood Deductible. It means the insurance company won't cover the cost of blood transfusions until the deductible is met.

Denial code 69 is for day outlier amount.

Denial code 7 means the procedure or revenue code doesn't match the patient's gender. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 70 is a code used by healthcare providers to indicate that an adjustment has been made to compensate for additional costs related to a cost outlier.

Denial code 74 is an Indirect Medical Education Adjustment that can affect healthcare providers' revenue cycle management.

Denial code 75 is a Direct Medical Education Adjustment that can affect healthcare providers' revenue cycle management.

Denial code 76 is for Disproportionate Share Adjustment. It means the healthcare provider's claim for additional payment was denied due to certain eligibility criteria not being met.

Denial code 78 is for non-covered days or room charge adjustments.

Denial code 8 means the procedure code doesn't match the provider's specialty. Check the 835 Healthcare Policy Identification Segment for more info.

Denial code 89 is when professional fees are taken out from the charges.

Denial code 90 is for ingredient cost adjustment in healthcare billing. It is used specifically for pharmaceuticals.

Denial code 91 is a dispensing fee adjustment that may affect healthcare providers' revenue cycle management.

Denial code 94 means the claim was processed for more than the allowed charges.

Denial code 95 means the insurance company won't cover the procedure because the proper plan guidelines weren't followed.

Denial code 96 is for non-covered charges. It means that there is missing information in the claim, such as a remark code. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code 97 means the payment for this service is already included in another service that has been processed. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code A0 is for patient refund amount.

Denial code A1 is a claim or service denial. It means that a remark code must be provided, which can be a NCPDP Reject Reason Code or a Remittance Advice Remark Code that is not an ALERT. This code should be used when a more specific Claim Adjustment Reason Code is not available.

Denial code A5 is for Medicare Claim PPS Capital Cost Outlier Amount.

Denial code A6 is when a patient's hospitalization or transfer doesn't meet the requirement of prior hospitalization or 30 days.

Denial code A8 is for an ungroupable DRG, which means the diagnosis-related group (DRG) code assigned to a patient's medical claim cannot be categorized properly.

Denial code B1 is for non-covered visits. It means that the healthcare provider's services are not covered by the patient's insurance plan.

Denial code B10 is when the allowed amount is reduced because a part of the procedure/test was already paid. The patient is not responsible for paying more than the charge limit for the procedure/test.

Denial code B11 is when the claim or service has been sent to the correct payer/processor for processing, but it is not covered by that payer/processor.

Denial code B12 is when the services provided are not properly documented in the patient's medical records.

Denial code B13 is for previously paid claims. It means that payment for this service may have already been provided in a previous payment.

Denial code B14 means only one visit or consultation per physician per day is covered.

Denial code B15 means a required service/procedure is missing or not covered. Check the 835 Healthcare Policy Identification Segment for more details.

Denial code B16: New Patient qualifications were not met. Understand why your healthcare claim was denied. Learn more about denial codes.

Denial code B20 means that the procedure or service was already provided by another healthcare provider.

Denial code B22 is a payment adjustment based on the diagnosis.

Denial code B23 is when the procedure billed is not authorized according to your CLIA proficiency test.

Denial code B4 is a late filing penalty that healthcare providers may encounter when submitting claims for reimbursement.

Denial code B7 means the provider was not certified/eligible to be paid for a specific procedure/service on a certain date. Check the 835 Healthcare Policy Identification Segment for more information.

Denial code B8 means alternative services were available and should have been used. Check the 835 Healthcare Policy Identification Segment for more info.

Denial code B9 means the patient is enrolled in a Hospice.

Denial code P1 is for state-mandated requirements for Property and Casualty claims. Check Claim Payment Remarks Code for more details. Only applicable to Property and Casualty.

Denial code P10 is used when payment is reduced to zero due to ongoing litigation. More details will be provided after the litigation is resolved. Only applicable for Property and Casualty cases.

Denial code P11 is used when the status of an injury or illness claim is pending due to legal action. It is specific to Property and Casualty claims. (Group Code OA)

Denial code P12 is a fee schedule adjustment related to workers' compensation claims. The payer and provider need to refer to specific segments in the 835 electronic remittance advice for more information. This code is applicable only for workers' compensation cases.

Denial code P13 is used when a payment is reduced or denied based on workers' compensation regulations. It is important for providers to refer to the insurance policy number or healthcare policy identification to understand the specific regulations that apply. This code is specific to Workers' Compensation claims.

Denial code P14 means the payment for this service is already included in another service performed on the same day. Check the 835 Healthcare Policy Identification Segment for more details. For Property and Casualty use only.

Denial code P15 is for Workers' Compensation Medical Treatment Guideline Adjustment. It is specific to Workers' Compensation claims.

Denial code P16 means the medical provider is not authorized to treat injured workers in this area. It's used for Workers' Compensation claims. (Use with Group Code CO or OA)

Denial code P17 is used when a referral is not authorized by the attending physician as required by regulations. This code is specific to Property and Casualty cases.

Denial code P18 is when a procedure is not listed in the fee schedule, but an allowance is made for a similar service. This code is specific to Property and Casualty claims.

Denial code P19 means no payment is due for a procedure because it has a value of zero in the fee schedule. It is only used for Property and Casualty claims.

Denial code P2 is for non-work related injuries/illnesses not covered by workers' compensation. Providers should refer to the insurance policy number or healthcare policy identification for jurisdictional regulations. Workers' compensation use only.

Denial code P20 is used when a service is not paid according to the allowed outpatient facility fee schedule. It is specific to Property and Casualty cases.

Denial code P21 is a payment denial based on jurisdictional regulations or payment policies for Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits. It is used for Property and Casualty Auto claims.

Denial code P22 is used when a payment is adjusted based on the jurisdictional regulations or payment policies related to Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits. It is specific to Property and Casualty Auto claims.

Denial code P23 is a fee schedule adjustment related to Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits. It is important for providers to refer to specific segments in the 835 document for further information. This code is applicable only for Property and Casualty Auto claims.

Denial code P24 is a payment adjustment based on a Preferred Provider Organization (PPO). It is used for Property and Casualty claims and should be referred to the 835 Class of Contract Code Identification Segment or the 835 Healthcare Policy Identification Segment for more information. Use with Group Code CO.

Denial code P25 is used when a payment is adjusted based on the Medical Provider Network (MPN). It is specific to Property and Casualty claims and should be referred to the appropriate code identification segments in the 835 transaction.

Denial code P26 is used when a payment is adjusted based on the Voluntary Provider network (VPN). It is specific to Property and Casualty claims and should be referred to in the 835 Class of Contract Code Identification Segment or the 835 Healthcare Policy Identification Segment, depending on the level of adjustment.

Denial code P27 is a payment denial based on jurisdictional regulations and/or payment policies for liability coverage benefits. Providers should refer to the insurance policy number segment or healthcare policy identification segment in the 835 for more information. Only applicable for Property and Casualty Auto.

Denial code P28 is for payment adjustments based on liability coverage benefits regulations. Providers should refer to the insurance policy number segment or healthcare policy identification segment in the 835 for more information. Only applicable for Property and Casualty Auto.

Denial code P29 is a fee schedule adjustment related to liability benefits. It can be at the claim or line level and requires the payer to send specific information to the provider. This code is applicable to Property and Casualty Auto only.

Denial code P3 is used when a Workers' Compensation case has been settled and the patient is responsible for the claim/service cost through a specific arrangement. This code is only applicable for Workers' Compensation cases.

Denial code P30 is used when payment is denied for an exacerbation due to incomplete supporting documentation. Only applicable for Property and Casualty cases.

Denial code P31 is used when payment is denied for an exacerbation when the treatment exceeds the allowed time. It is specific to Property and Casualty cases.

Denial code P32 is when a payment is adjusted because it needs to be divided among multiple parties.

Denial code P4 is when a Workers' Compensation claim is deemed non-compensable. The payer is not responsible for the claim or service/treatment. For more information, providers should refer to the 835 Insurance Policy Number Segment or the 835 Healthcare Policy Identification Segment. This code is specific to Workers' Compensation claims.

Denial code P5 is used when a payer determines that the fees charged by a healthcare provider are not reasonable and customary. This code is specific to Property and Casualty claims.

Denial code P6 is based on entitlement to benefits. Providers should refer to the insurance policy number segment or healthcare policy identification segment for jurisdictional regulations. Used for Property and Casualty only.

Denial code P7 is when the billed code is not found in the fee schedule/fee database. Resubmit the bill with the correct code and supporting documentation. For Property and Casualty only.

Denial code P8 is for claims under investigation. Providers should refer to the 835 Insurance Policy Number Segment or the 835 Healthcare Policy Identification Segment for more information. Property and Casualty only.

Denial code P9 is used when there is no appropriate code to describe a service. It is specifically for Property and Casualty cases.