RCM- Denials Code.

Denials Code

https://med.noridianmedicare.com/web/jddme/topics/ra/denial-resolution

OA-23: Indicates the impact of prior payers(s) adjudication, including payments and/or adjustments. No action required since the amount listed as OA-23 is the allowed amount by the primary payer. 

CO 24 If the patient is already covered under the Medicare Advantage Plan. Capitation.

OA-109: Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

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

Reason Code: 119 Benefit maximum for this time period or occurrence has been reached.

4 The procedure code is inconsistent with the modifier used.

5 The procedure code/type of bill is inconsistent with the place of service. 

6 The procedure/revenue code is inconsistent with the patient's age. 

7 The procedure/revenue code is inconsistent with the patient's gender.  

8 The procedure code is inconsistent with the provider type/specialty (taxonomy). N95 This provider type/provider specialty may not bill this service. 

9 The diagnosis is inconsistent with the patient's age. 

10 The diagnosis is inconsistent with the patient's gender.

11 The diagnosis is inconsistent with the procedure.

13 The date of death precedes the date of service. 

16 Claim/service lacks information or has submission/billing error(s).  M50 Missing/incomplete/invalid revenue code(s). 

16 Claim/service lacks information or has submission/billing error(s).  M52 Missing/incomplete/invalid "from" date(s) of service. 

16 Claim/service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other documentation. MA120 Missing/incomplete/invalid CLIA certification number.

16 Claim/service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other documentation. N34 Incorrect claim form/format for this service.

16 Claim/service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other documentation. N152 Missing/incomplete/invalid replacement claim information.

16 Claim/service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other documentation. N341 Missing/incomplete/invalid surgery date.

22 This care may be covered by another payer per coordination of benefits.

24 Charges are covered under a capitation agreement/managed care plan. 

27 Expenses incurred after coverage terminated. 

29 The time limit for filing has expired.

31 Patient cannot be identified as our insured.

50 These are non-covered services because this it not deemed a 'medical necessity' by the payer.

54 Multiple physicians/assistants are not covered in this case. 

58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.

60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.

96 Non-covered charge(s). M2 Not paid separately when the patient is an inpatient.

96 Non-covered charge(s). N30 Patient ineligible for this service.

97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. 

97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. M86 Service denied because payment already made for same/similar procedure within set time frame. 

109 Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.

119 Benefit maximum for this time period or occurrence has been reached.

119 Benefit maximum for this time period or occurrence has been reached. N362 The number of Days or Units of Service exceeds our acceptable maximum. 

170 Payment is denied when performed/billed by this type of provider. N95 This provider type/provider specialty may not bill this service. 

185 The rendering provider is not eligible to perform the service billed.

190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.. 

197 Precertification/authorization/notification/pre-treatment absent. 

199 Revenue code and Procedure code do not match.

200 Expenses incurred during lapse in coverage.

204 This service/equipment/drug is not covered under the patient's current benefit plan.

206 National Provider Identifier - Missing .

234 This procedure is not paid separately. N20 Service not payable with other service rendered on the same date.

272 Coverage/program guidelines were not met. 

B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service.