Denial Codes and Solutions

PR204 denial code – When a service/equipment/drug is not covered by the patient’s insurance plan, then those claims will be

Denial Codes with actions No Claim on file Claim is in process Claim Paid Status PR 1 – Claim applied

Insurance companies deny the claims for various reasons, and those denied claims will be denoted with denial codes. These denial

Denial Code CO 197 also called as PR197 denial code – Payment adjusted for the absence of precertification/authorization It is

What is denial code CO 119 – Maximum benefit exhausted/met It is the benefit limits. It may be either the

Denial Code CO 109 Most frequently, we receive this denial code CO 109 from Medicare insurance company. It means claim

Denial Code CO 97 – The benefit for the service or procedure is inclusive/bundled in the allowance/payment for another service/procedure

Denial Code CO 96 – Non covered charges Denial code CO 96 Resolution: Below are some of the scenarios we

Denial Code CO 50 – Non covered services not deemed a medical necessity When insurance company find the treatment rendered

Denial Code CO 31 also called as PR31 denial code – Patient Cannot be identified as our insured. If insurances