What Is A Reason Code Used On An EOB?

What is denial code CO 151?

Description.

Reason Code: 151.

Payment adjusted because the payer deems the information submitted does not support this many/frequency of services..

What is Co 45 denial code?

Denial code CO 45: Charges exceed your contracted/legislated fee arrangement. Kindly note this adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication.

What is an EOB code?

An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice.

What is denial code Co 59?

CO 59 – Processed based on multiple or concurrent procedure rules. Reason and action: This is Multiple surgeries detected, hence confirm with coding guideliness and take the necessity action.

What are reasons codes?

Reason codes, also called score factors or adverse action codes, are numerical or word-based codes that describe the reasons why a particular credit score is not higher. For example, a code might cite a high utilization rate of available credit as the main negative influence on a particular credit score.

What is denial code Co 97?

CO-97: The payment was adjusted because the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Resubmit the claim with the appropriate modifier or accept the adjustment.

What does denial code OA 23 mean?

Code OA is used to identify this as an administrative adjustment.……. … Any further adjustment, taken by Medicare as a result of previous payer(s) payment and/or adjustment(s), with Group Code OA and Claim Adjustment Reason Code 23.

What does PR 22 mean?

Reason for Denial Secondary paymentPR 22 This care may be covered by another payer per coordination of benefits. Reason for Denial. Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.

What are claim adjustment reason codes?

Claim Adjustment Reason Codes detail the reason why an adjustment was made to a health care claim payment by the payer, while Remittance Remark Codes represent non-financial information critical to understanding the adjudication of a health insurance claim.

What is a remark code on a claim?

Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing.

What does PR 96 mean?

PR 96 Denial Code: Patient Related Concerns When a patient meets and undergoes treatment from an Out-of-Network provider. Based on Provider’s consent bill patient either for the whole billed amount or the carrier’s allowable.

What does PR 204 mean?

PR-204: This service/equipment/drug is not covered under the patient’s current benefit plan.

What does Medicare denial code Co 150 mean?

CO 150. Payer deems the information submitted does not support this level of service. Check the date span and the units billed for the procedure code(s) that denied. It is likely there are overlapping dates of service causing an overage per the Local Coverage Determination (LCD).