Common Reasons for Claim Denials
Common Reasons for Claim Denials
- CO-16: Claims lacking required information or having submission errors.
- CO-50: Non-covered services under the patient’s plan, often because the service is experimental or outside the plan’s scope.
- CO-45: Charges exceeding the payer’s allowable amount, leading to adjustments or partial denials.
- CO-18: Duplicate claims are flagged when a provider submits the same service multiple times.
- CO-11: Inconsistent diagnosis and procedure codes, where the diagnosis doesn’t justify the medical necessity of the service.
- CO-27: Expenses incurred after a patient’s coverage has expired or terminated.
- CO-22: Indicates coordination of benefits issues, where another payer should be billed first.
- CO-96: Denotes non-covered charges, which could fall under policy exclusions or specific plan limitations.
- CO-109: When a claim is submitted to the wrong payer, this code denotes that the payer does not cover the service.
- CO-29: The time limit for filing the claim has expired, so it cannot be processed.
- CO-197: A missing precertification or prior authorization often results in this code.
- CO-151: Insufficient documentation for the level of service billed, suggesting a mismatch between billing codes and clinical documentation.
- CO-31: The insurer cannot identify the patient as their insured, usually due to incorrect patient information.
- CO-183: The referring provider is ineligible to refer for the service, often linked to credentialing issues.
- CO-97: Denied when a service is bundled with another and not reimbursed separately.