204 This service/equipment/drug is not covered under the patients current benefit plan
Check whether patient has any other insurance or Need to bill the patient
18 Duplicate claim/service.
Need to check the claim status and take appropriate step
OA-23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments
Take w.o
16 Claim/service lacks information, which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate.
Need to refile the claim along with requested information.
DN001 Prior Authorization is required but was not obtained
Need to refile the claim along with authorization number
29 The time limit for filing has expired.
Need to refile the claim along with appeal letter and timely filing limit proof
96 Non – Covered charges
Need to change Dx or update appropriate modifier after consult with coding department.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits.
Need to file the claim to correct payer
97 Payment is included in the allowance for another service/procedure.
Need to change Dx or update appropriate modifier after consult with coding department.
56 Need primary insurance EOB
Need to refile the claim along with primary insurance EOB
Medical billing basics
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Insurance verification process
Medicare as secondary payor
Insurance claim denied
Denial claim example
Health insurance claim denials
Insurance denial appeal letter
Denial claim
