Claims Denial Codes
| Code |
Description |
| 001 |
REASONABLE AND CUSTOMARY FEE ALLOWED |
| 002 |
PLEASE SEND LETTER OF MEDICAL NECESSITY |
| 003 |
PRIOR TO EFFECTIVE DATE OR AFTER TERMINATION DATE |
| 004 |
SERVICE NOT COVERED BY BENEFIT |
| 007 |
AGE INVALID FOR SERVICE |
| 009 |
SEX DOES NOT MATCH TYPE OF SERVICE |
| 010 |
SUBMIT TO PRIMARY COVG & RETURN EOB FOR PROCESSING |
| 014 |
DEDUCTIBLE REACHED |
| 015 |
MAXIMUM COVERAGE AMOUNT REACHED |
| 017 |
SEX INVALID FOR COVERAGE |
| 018 |
AGE INVALID FOR COVERAGE |
| 028 |
MAXIMUM NUMBER OF VISITS MET |
| 029 |
MAXIMUM OUT OF POCKET LIMITATION REACHED |
| 034 |
AGE INVALID FOR DIAGNOSIS |
| 035 |
SEX INVALID FOR DIAGNOSIS |
| 037 |
GROUP NOT EFFECTIVE FOR DATE OF SERVICE |
| 042 |
INVALID SERVICE CODE |
| 053 |
MEMBER NOT ELIGIBLE FOR BENEFIT |
| 081 |
AUTH DAYS EXCEEDED |
| 099 |
DUPLICATE CHARGE PREVIOUSLY PROCESSED |
| 33A |
NO ALLOWABLE CHG FOR SVC |
| 51A |
GROUP NOT SET UP FOR DISABILITY |
| A07 |
ASSISTANT NOT APPROVED BY DSS |
| A10 |
AUTHORIZATION DENIED |
| A11 |
AUTH REQUIRE NOT FOUND |
| A21 |
ADHERE TO ORIGINAL DENIAL |
| ADJ |
REVERSAL/ADJUSTMENT |
| AGE |
PATIENT AGE SVC NOT COVERED |
| AH1 |
MUL BEN PKGS W/IN CLAIM SUB, SPLIT DEC/JAN & RESUB |
| AI1 |
MUL FEE SCH W/IN CLAIM SUB, SPLIT MAR/APR & RESUB |
| AL1 |
MANUAL ADJ SPLIT CHGS/NEW CLAIM |
| AP1 |
BILL RX VENDOR |
| AT1 |
REBILL W/ ANESTHESIA TIME |
| AU1 |
AUTH/BILLED DATE DISCREPANCY |
| B11 |
762 NOT ALLOWED W/720/729 |
| B31 |
DENY RCC 720/729 IF WITH 762 |
| BA1 |
NOT COVERED BY YOUR HEALTH BENEFITS PLAN |
| BC1 |
BILL BENECARE |
| BD1 |
CLAIM REJ: BILL BHP/EDS |
| BE1 |
SERVICE OR DIAGNOSIS EXCLUDED BY PLAN |
| BE2 |
SERVICE NOT COVERED FOR THIS PROVIDER |
| BG1 |
SERVICE NOT WITHIN BENEFIT GUIDELINES |
| BL |
SUBMIT TO BLOCK VISION |
| BM1 |
NOT MEDICALLY APPROPRIATE |
| BN1 |
NOT MEDICALLY NECESSARY |
| C11 |
CHARGES BILLED IN ERROR |
| C21 |
MAXIMIM BENEFIT REACHED |
| C41 |
PYMT MADE ON EXCEPTION BASIS |
| C91 |
RESUBMIT W/ CPT CODES |
| CA1 |
UNTIMELY APPEAL |
| CD1 |
DELETED CODE- REBILL |
| CE1 |
PROVIDER NAME MISSING OR INVALID |
| CF1 |
SUBMIT CHARGE TO DSS |
| CL1 |
NO VALID CT LICENSE |
| DCR |
DESCRIPTION OF CODE REQUIRED |
| DDC |
DX CODE DELETED |
| DPH |
PART OF DPH/VFC |
| DSC |
SVC CODE DELETED |
| DX3 |
DX MISSING/INVALID |
| ED1 |
INCLUDED IN ER CASE RATE |
| ED2 |
INCLUDED IN ER VISIT |
| EG1 |
DIAGNOSIS EXCLUDED BY PLAN |
| ES1 |
SERVICE EXCLUDED BY PLAN |
| EVM |
DENY PART OF E&M CODE |
| FDT |
FUTURE DOS |
| FR2 |
CONSENT FORM RECIEVED |
| GC1 |
DENY PURCHASE ONLY |
| GD1 |
DENY RENTAL ONLY |
| H21 |
PLEASE SUBMIT W/CPT |
| H81 |
981/983 N/C W/ 456 |
| HD1 |
BILL TO EDS |
| HF1 |
RESUBMIT ON HCFA (08-05) FORM |
| HP1 |
INVALID RCC/CPT COMBINATION |
| HP2 |
DENY SUBMIT WITH CPT CODE |
| I11 |
INCLUDED IN IP STAY |
| IB |
INCORRECT BILLING |
| IC1 |
INCLUDED IN CASE RATE |
| IF1 |
IMPROPER FORM SUBMITTED |
| IM1 |
INCIDENTAL TO MAIN PROCEDURE |
| IR1 |
INCL IN COMP RATE |
| IU1 |
SUBMIT ITEMIZED BREAKDOWN |
| L11 |
LACK OF MEDICAL INFO |
| L21 |
LATE UR NOTIFICATION |
| LBR |
INCL IN AUTO TEST PANEL |
| LPR |
INCL IN AUTO TEST PANEL |
| MD1 |
MODIFIER INVALID |
| MF1 |
MODIFIER INVALID FOR CODE |
| MG1 |
BILL MAGELLAN |
| MI1 |
NEED MEDICAL RECORDS |
| MO1 |
MODIFIER REQUIRED |
| MV1 |
SUBMIT TO BEHAVIORAL HEALTH VENDOR |
| N11 |
NOT SUBMITTED TIMELY |
| N61 |
DENY MISSING BILLING NPI |
| N71 |
DENY MISSING RENDERING NPI |
| NC1 |
NDC CODE REQUIRED |
| ND1 |
RESUBMIT WITH NDC, DRUG, AND DOSAGE |
| NE1 |
NON CONTRACTED PROVIDER |
| NF1 |
MBR NAME/ID MISMATCH |
| NM1 |
NEWBORN- MOM'S ID NO CLAIMS |
| NR1 |
NO FEE SET BY DSS |
| NRD |
NOT REIMBURSED BY THE DSS |
| NS1 |
BILLING NPI REQ OR FUTURE CLAIMS WILL BE DENIED |
| NT1 |
RENDERING NPI REQ OR FUTURE CLAIMS WILL BE DENIED |
| NU1 |
ATTENDING NPI REQ OR FUTURE CLAIMS WILL BE DENIED |
| O11 |
OVERPAYMENT |
| OP1 |
SUBMIT OP & PATH RPT |
| P11 |
PROC\NDC CODE INVALID |
| P21 |
PROCEDURE CODE INACTIVE |
| P31 |
PROV NOT RECREDENTIALED |
| P51 |
PROV NOT ACTIVE AT THIS SITE |
| P84 |
DX CODE REQUIRES 5 DIGITS |
| PG1 |
SUBMIT REN/ATTN PROV NAME |
| PI1 |
INVALID PROVIDER |
| PL1 |
DENIED FOR INSUFFICIENT PROVIDER INFORMATION |
| PN1 |
NON PAR PROVIDER |
| PS1 |
BILLED W/ WRONG POS |
| PW1 |
ADDITIONAL PROVIDER INFORMATION REQUIRED |
| PY1 |
CALL TO VERIFY PROVIDER INFO |
| R11 |
REV-DENED IN ERROR |
| R21 |
PATIENT NOT SEEN ON DOS |
| R31 |
RESUBMIT UNALTERED BILL |
| R61 |
REV LATE CHARGES ADJUSTMENT |
| R71 |
REV PER PROVIDER RELATION |
| R81 |
REV PER MEMBER SERVICES |
| R91 |
REV PER VPO |
| RB1 |
RESUBMISSION CORRECTED BILL |
| RD1 |
REV CLAIMS MANAGER |
| RO1 |
ORIG CLM OVERPD, REV UPON REFUND |
| RS1 |
RECORDS UNDER REVIEW |
| S11 |
SERVICE INCLUDED IN CAP |
| S41 |
VACCINE NOT BILLED W/ ADM |
| SD1 |
SAGA-500 SERIES RCVD |
| SE1 |
SAGA RETRO ENROLLEE |
| SF1 |
STERIL FORM N/REC'D |
| SJ1 |
CONSENT FORM RECEIVED |
| SL |
STATE SUPPLIED VACCINE |
| SN1 |
SUBMIT SCHOOL NAME |
| SR1 |
CHN WILL FWD TO EDS |
| SRD |
SAGA RETRO DIS-ENROLLEE |
| SS1 |
SAGA OUT-OF-STATE NOT COVERED |
| TM1 |
TIMEFRAME NOT MET |
| TVN |
TRAVEL VACCINE NOT COVERED |
| UB1 |
RESUBMIT ON UB-04 FORM |
| VAD |
BILLED W/O VACCINE |
| X04 |
VENDOR DENIED CLAIM (USE FOR XTRA STEPP) |
| Z01 |
NOT MEDICALLY NECESSARY |
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