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Revenue Cycle Management

Healthcare Guide for Reimbursement

  • Denial Codes
    • Denials with solutions in Medical Billing
    • Denials Management – Causes of denials and solution in medical billing
    • Medical Coding denials with solutions
    • Offset in Medical Billing with Example
    • PR 1 Denial Code – Deductible Amount
    • CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a required modifier is missing
    • CO 5 Denial Code – The Procedure code/Bill Type is inconsistent with the Place of Service
    • CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age
    • CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender
    • CO 9 and CO 10 Denial Code
    • CO 13 and CO 14 Denial Code
    • CO 15 Denial Code – The authorization number is missing, invalid, or does not apply to the billed services or provider
    • CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete
    • CO 19 Denial Code – This is a work-related injury/illness and thus the liability of the Worker’s Compensation Carrier
    • CO 20 and CO 21 Denial Code
    • CO 23 Denial Code – The impact of prior payer(s) adjudication including payments and/or adjustments
    • CO 26 CO 27 and CO 28 Denial Codes
    • CO 31 Denial Code- Patient cannot be identified as our insured
    • CO 45 Denial Code
    • CO 97 Denial Code
    • CO 119 Denial Code – Benefit maximum for this time period or occurrence has been reached or exhausted
  • Place of Service Codes
    • Place of Service 02
    • Place of Service 11
    • Place of Service 12
    • Place of Service 19
    • Place of Service 21
    • Place of Service 22
    • Place of Service 23
  • Medicaid Phone Number
    • Tricare Phone Number and Claim Address
    • Molina Healthcare Phone Number claims address of Medicare and Medicaid
      • BCBS Provider Phone Number
        • BCBS Prefix List
        • BCBS Federal Phone Number
        • Ambetter Claims address and Phone Number
        • Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit
        • Kaiser Permanente Phone Number – Claims address and Timely Filing Limit
        • Amerihealth Caritas Phone Number, Payer ID and Claim address
  • United Healthcare Provider Number
  • Medical Coding
    • Anxiety ICD 10
    • ICD 10 code for Abdominal Pain
    • Back Pain ICD 10
    • Chest Pain ICD 10
    • Diabetes ICD 10 – Mellitus and Insipidus
    • Pregnancy ICD 10
    • Arthritis ICD 10
    • Asthma ICD 10
    • GERD ICD 10
    • Hypothyroidism ICD 10
    • Hyperlipidemia ICD 10
    • Hypertension ICD 10
    • ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples
    • ICD 10 code for HIV
    • E&M Codes
    • CPT Code for Consultation
    • Modifiers GA GX GY and GZ
    • Modifiers GV and GW
    • Modifier 26
    • Modifier 50
    • Modifier 52
    • Modifier 62
    • Modifier 76 and 77
    • Modifier 80 and 66
  • Aetna address and Provider Phone Number
  • Timely Filing Limit of Insurances
    • Anthem Blue Cross Blue Shield Timely filing limit – BCBS TFL List
    • Ambetter Timely Filing Limit
  • Workers Compensation
    • Workers Compensation Insurances List of United States
    • Workers Compensation time limit for filing Claim and reporting in United States
  • Health Insurance in US
    • What is Medical Billing and Medical Billing process steps in USA?
    • Demo Entry in Medical Billing
    • Charge Entry in Medical Billing
    • Clearing House in Medical Billing
    • Payment Posting in Medical Billing
    • Medical Terminology
    • Contact Us
    • Privacy Policy
    • About Us
  • BCBS Prefix List AAA to AZZ
  • BCBS Prefix List BAA to BZZ
  • BCBS Prefix List CAA to CZZ
  • BCBS Prefix List DAA to DZZ
  • BCBS Prefix List EAA to EZZ
  • BCBS Prefix List FAA to FZZ
  • BCBS Prefix List GAA to GZZ
  • BCBS Prefix List HAA to HZZ
  • BCBS Prefix List IAA to IZZ
  • BCBS Prefix List JAA to JZZ
  • BCBS Prefix List KAA to KZZ
  • BCBS Prefix List LAA to LZZ
  • BCBS Prefix List MAA to MZZ
  • BCBS Prefix List NAA to NZZ
  • BCBS Prefix List OAA to OZZ
  • BCBS Prefix List PAA to PZZ
  • BCBS Prefix List QAA to QZZ
  • BCBS Prefix List RAA to RZZ
  • BCBS Prefix List SAA to SZZ
  • BCBS Prefix List TAA to TZZ
  • BCBS Prefix List UAA to UZZ
  • BCBS Prefix List VAA to VZZ
  • BCBS Prefix List WAA to WZZ
  • BCBS Prefix List XAA to XZZ
  • BCBS Prefix List YAA to YZZ
  • BCBS Prefix List ZAA to ZZZ
  • BCBS Prefix List A2A to A9Z
  • BCBS Prefix List B2A to B9Z
  • BCBS Prefix List C2A to C9Z
  • BCBS Prefix List D2A to D9Z
  • BCBS Prefix List E2A to E9Z
  • BCBS Prefix List F2A to F9Z
  • BCBS Prefix List G2A to G9Z
  • BCBS Prefix List H2A to H9Z
  • BCBS Prefix List I2A to I9Z
  • BCBS Prefix List J2A to J9Z
  • BCBS Prefix List K2A to K9Z
  • BCBS Prefix List L2A to L9Z
  • BCBS Prefix List M2A to M9Z
  • BCBS Prefix List N2A to N9Z
  • BCBS Prefix List O2A to O9Z
  • BCBS Prefix List P2A to P9Z
  • BCBS Prefix List Q2A to Q9Z
  • BCBS Prefix List R2A to R9Z
  • BCBS Prefix List S2A to S9Z
  • BCBS Prefix List T2A to T9Z
  • BCBS Prefix List U2A to U9Z
  • BCBS Prefix List V2A to V9Z
  • BCBS Prefix List W2A to W9Z
  • BCBS Prefix List X2A to X9Z
  • BCBS Prefix List Y2A to Y9Z
  • BCBS Prefix List Z2A to Z9Z

Denial Codes – Healthcare

Denial Codes - Healthcare 

CO 45 Denial Code

November 27, 2020 Channagangaiah

CO 45 Denial Code – Charges exceed the fee schedule/maximum allowable or contracted/legislated fee arrangement. This CO 45 Denial code

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Denial Codes - Healthcare 

CO 97 Denial Code

November 19, 2020 Channagangaiah

Insurance deny the claim with CO 97 denial code, when procedure code is inclusive with the other procedure code billed

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Denial Codes - Healthcare 

CO 197 Denial Code – Precertification/authorization/notification absent

November 17, 2020 Channagangaiah

Whenever claim denied with CO 197 Denial Code – Pre-certification/authorization/notification absent, it means authorization number is missing for the services

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Denial Codes - Healthcare 

Denials with solutions in Medical Billing

May 25, 2020May 25, 2020 Channagangaiah
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Denial Codes - Healthcare 

Medical Coding denials with solutions

May 25, 2020May 25, 2020 Channagangaiah
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Denial Codes - Healthcare 

Denials Management – Causes of denials and solution in medical billing

April 14, 2020April 14, 2020 Channagangaiah

Denials Management in Healthcare – Medical Billing: For proper denials management of medical claims in medical billing, first we need

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Denial Codes - Healthcare 

CO 119 Denial Code – Benefit maximum for this time period or occurrence has been reached or exhausted

January 28, 2020February 13, 2020 Channagangaiah

Insurances will deny the claim as Denial Code CO 119 – Benefit maximum for this time period or occurrence has

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Denial Codes - Healthcare 

Offset in Medical Billing with Example

January 28, 2020February 28, 2020 Channagangaiah

What is offset in medical billing? When an insurance company makes a wrong or excess payment to its provider, it

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Denial Codes - Healthcare 

CO 31 Denial Code- Patient cannot be identified as our insured

January 24, 2020February 13, 2020 Channagangaiah

CO 31 Denial Code- Patient cannot be identified as our insured: Insurance will deny the claim with CO 31 Denial

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Denial Codes - Healthcare 

CO 26 CO 27 and CO 28 Denial Codes

January 24, 2020February 25, 2020 Channagangaiah

CO 26 Denial Code – Expenses incurred prior to coverage: Payers will deny the claims with CO 26 Denial Code

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Denial Codes - Healthcare 

CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a required modifier is missing

January 24, 2020February 18, 2020 Channagangaiah

Insurance will deny with CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a

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Denial Codes - Healthcare 

CO 23 Denial Code – The impact of prior payer(s) adjudication including payments and/or adjustments

January 23, 2020February 13, 2020 Channagangaiah

As we know when the claims submitted to secondary insurance for balance, secondary insurance will process and allow the claim

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Denial Codes - Healthcare 

CO 20 and CO 21 Denial Code

January 23, 2020February 28, 2020 Channagangaiah

CO 20 Denial Code – This injury/illness is covered by the liability carrier: Insurance will deny the claim with CO

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Denial Codes - Healthcare 

CO 19 Denial Code – This is a work-related injury/illness and thus the liability of the Worker’s Compensation Carrier

January 23, 2020February 6, 2020 Channagangaiah

Insurance company will deny the claim with CO 19 denial code – This is a work related injury/illness and thus

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Denial Codes - Healthcare 

CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete

January 23, 2020February 13, 2020 Channagangaiah

Insurance will be denying the claim as CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete,

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Denial Codes - Healthcare 

CO 15 Denial Code – The authorization number is missing, invalid, or does not apply to the billed services or provider

January 23, 2020February 28, 2020 Channagangaiah

If the services billed require authorization, then insurance will deny the claim with CO 15 denial code – The authorization

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Denial Codes - Healthcare 

CO 13 and CO 14 Denial Code

January 23, 2020February 14, 2020 Channagangaiah

CO 13 Denial Code – The date of death precedes the date of service. Insurance will deny the claim with

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Denial Codes - Healthcare 

CO 9 and CO 10 Denial Code

January 23, 2020February 26, 2020 Channagangaiah

CO 9 Denial Code – The diagnosis code is inconsistent with the patient’s age: Insurance will deny the claim with

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Denial Codes - Healthcare 

CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender

January 23, 2020February 13, 2020 Channagangaiah

When the claim denied as CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender means

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Denial Codes - Healthcare 

CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age

January 23, 2020February 18, 2020 Channagangaiah

When the claim says CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, it means

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Denial Codes - Healthcare 

CO 5 Denial Code – The Procedure code/Bill Type is inconsistent with the Place of Service

January 23, 2020February 14, 2020 Channagangaiah

Insurances Company will be denying the claim with CO 5 Denial Code – Procedure code/Bill Type is inconsistent with the

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Denial Codes - Healthcare 

PR 1 Denial Code – Deductible Amount

January 23, 2020February 6, 2020 Channagangaiah

When the insurance process the claim towards PR 1 denial code – Deductible amount, it means they have processed and

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Denial Codes - Healthcare 

Denial Codes

December 6, 2019February 29, 2020 Channagangaiah

Denial Codes in Medical Billing – Lists: CO – Contractual Obligations OA – Other Adjsutments PI – Payer Initiated reductions

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Categories

  • Aetna Directory – Healthcare (1)
  • Ambetter Directory – Healthcare (1)
  • Amerihealth Caritas Directory – Healthcare (1)
  • CPT Codes Guide – Healthcare (7)
  • Denial Codes – Healthcare (23)
  • Durable Medical Equipment – Healthcare (1)
  • Health Insurance in United States of America (3)
  • Healthfirst Directory (1)
  • ICD 10 Codes Guide – Healthcare (32)
  • Kaiser Permanente Directory – Healthcare (1)
  • Medicaid Directory – Healthcare (1)
  • Medical Billing Cycle – Healthcare (8)
  • Medical Terminology List – Healthcare (2)
  • Modifiers Guide – Healthcare (11)
  • Molina Directory – Healthcare (1)
  • Place of Service Codes List – Medical Billing (11)
  • Timely Filing Limit – Healthcare (3)
  • Tricare Directory – Healthcare (1)
  • Uncategorized (55)
  • Unitedhealthcare Directory – Healthcare (1)
  • Workers Compensation – Healthcare (3)

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