AR Denials & Actions
AR Denials & Actions
AR Denials & Actions
Denial Action: : Submit the claims with Authorization number or valid authorization
Denial Code (Remarks): CO 16
Denial reason: Claim/service lacks information which is needed for adjudication. At least
one Remark Code must be provided (may be comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason Code.)
Denial Action: : Check with other remark codes started as N/M and correct the claims
Denial Code (Remarks): PR 1
Denial reason: Deductible amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): PR 2
Denial reason: Coinsurance amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): PR 3
Denial reason: Copay amount
Denial Action: Billed to secondary insurance/patient
Denial Code (Remarks): CO 4
Denial reason: The procedure code is inconsistent with the modifier used or a required
modifier is missing.
Denial Action: Use appropriate modifier with respective of procedure
Denial Code (Remarks): CO 5
Denial reason: The procedure code/bill type is inconsistent with the place of service.
Denial Action: Correct the Place of service or correct the procedure with respect of place
of service.
Denial Code (Remarks): CO 6
Denial reason: The procedure/revenue code is inconsistent with the patient's age.
Denial Action: Correct the procedure code with respect of patient's age
Denial Code (Remarks): CO 7
Denial reason: The procedure/revenue code is inconsistent with the patient's gender.
Denial Action: Correct the procedure code with respect of patient's gender (SexMale/Female)
Denial Code (Remarks): CO 9
Denial reason: The diagnosis is inconsistent with the patient's age.
Denial Action: : Correct the diagnosis code with respect of patient's age
Denial Code (Remarks): CO 10
Denial reason:The diagnosis is inconsistent with the patient's gender.
Denial Action: : Correct the diagnosis code with respect of patient's gender (SexMale/Female)
Denial Code (Remarks): CO 11
Denial reason: The diagnosis is inconsistent with the procedure.
Denial Action: : Correct the diagnosis code.
Denial Code (Remarks): CO 13
Denial reason: The date of death precedes the date of service.
Denial Action: : Correct the Date of service
Denial Code (Remarks): CO 14
Denial reason: The date of birth follows the date of service.
Denial reason: Non-covered charge(s). At least one Remark Code must be provided (may
be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason
Code.)
Denial Action: : Correct the diagnosis codes
Denial reason:t Payment adjusted because `New Patient' qualifications were not met.
Denial Action: : Submit the claims with established patient visit
Denial Code (Remarks): PR B9
Denial reason:t Services not covered because the patient is enrolled in a Hospice.
Denial Action: : Submit the claims with GV modifier