Medical Billing Denials and Solutions

Insurance companies deny the claims for various reasons, and those denied claims will be denoted with denial codes. These denial Codes explain why insurances cannot reimburse the claim billed and help the provider to correct those claims if required and resubmit again to insurance company with required information for reimbursement.

Most common and top denials in medical billing are listed below- please click on the link below for resolutions of each denials:

Denial Code CO 4 – Claim denied for CPT inconsistent with a modifier or Billed CPT is not valid for the modifier or vice versa.	Denial Code CO 29 – Claim denied as timely filing limit to file the claim has expired.
Denial Code CO 11 – Claim denied for CPT inconsistent with diagnosis or Billed CPT is not valid for the diagnosis or vice versa.	Denial Code CO 31 – Claim denied as patient cannot be identified as our insured.
Denial Code CO 16 – Claim denied as lacks information for adjudication.	Denial Code CO 50 – Claim denied for Not Medically necessary to perform the service.
Denial Code CO 18 – Claim denied as duplicate.	Denial Code CO 96 – Claim denied for Non covered Service.
Denial Code CO 22 – Claim denied as this care may be covered by another payer as per COB.	Denial Code CO 97 – Claim denied for Inclusive/Bundled and it is not separately reimbursable.
Denial Code CO 23 – Primary paid more than secondary allowed amount.	Denial Code CO 109 – Claim denied as it is not covered by this payer or contractor.
Denial Code CO 24 – Claim denied as charges are covered under capitation agreement or managed care plan.	Denial Code CO 119 – Claim denied for Maximum Benefit Exhausted.
Denial Code CO 27 – Claim denied as patient is not eligible for the date of service (Coverage terminated) and Denial Code CO 26 – Claim denied as Expenses incurred prior to coverage.	Denial Code CO 197 – Claim denied for No authorization on file.

Denial Codes with Actions

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