List Of Denial Codes In Medical Billing Pdf
If you work in medical billing, you know how important it is to get claims paid on time. However, sometimes claims get denied, and it can be frustrating to figure out why. Denial codes are used to explain why a claim was denied, and there are many different codes that can be used for various reasons. In this article, we will go over the most common denial codes you may encounter while working in medical billing.
CO - Contractual Obligations
The CO denial code is used when a claim is denied because the service provided is not covered by the patient's insurance plan. It could also mean that the service was not medically necessary or was already paid for under a different claim.
PR - Patient Responsibility
The PR code is used when a claim is denied because the patient has not met their deductible or co-pay requirements. It could also mean that the service provided was not covered by the patient's insurance plan.
NM - No Authorization
The NM denial code is used when a claim is denied because the service provided required prior authorization, and the authorization was not obtained before the service was provided. It could also mean that the authorization was denied or expired.
OA - Other Adjudication
The OA code is used when a claim is denied for reasons other than those covered by the other denial codes. This could include things like incorrect coding or billing errors.
PI - Payment Intact
The PI code is used when a claim is denied because payment has already been made for the service provided. This could happen if the insurance company already paid for the same service under a different claim, or if the patient paid for the service out of pocket.
CR - Correction Required
The CR code is used when a claim is denied because there are errors or omissions in the billing information. This could include things like incorrect patient information, incorrect billing codes, or missing information.
Conclusion
Understanding the reasons for claim denials is an essential part of medical billing. By knowing the most common denial codes, you can more effectively process claims and minimize the likelihood of denials. Keep in mind that different insurance companies may use different denial codes, so it's essential to review each claim's explanation of benefits carefully. By doing so, you can ensure that you are providing accurate and timely billing information, ultimately resulting in more timely payments and increased revenue for your practice.
