Search common medical billing claim denial codes to instantly see what they mean and how to fix them.
Showing 21 of 21 denial codes
Contractual Obligation
Description
The diagnosis is inconsistent with the procedure. The reported ICD-10 code does not support medical necessity for the billed CPT/HCPCS code.
Suggested Fix / Action
Review the documentation and link a diagnosis that supports the procedure. Correct the code pairing and resubmit a corrected claim.
Contractual Obligation
Description
The authorization number is missing, invalid, or does not apply to the billed services or provider.
Suggested Fix / Action
Verify the prior authorization number, dates, and approved services. Add the correct authorization and resubmit.
Contractual Obligation
Description
The claim or service lacks information or has submission/billing errors. Usually paired with a remark code identifying the missing data.
Suggested Fix / Action
Read the accompanying RARC remark code, supply the missing or corrected field (NPI, modifier, demographics), and resubmit.
Contractual Obligation
Description
Exact duplicate claim or service. The same claim was already submitted.
Suggested Fix / Action
Confirm whether the original claim was paid or is pending. Do not resubmit duplicates; appeal only if the original was incorrectly denied.
Contractual Obligation
Description
This care may be covered by another payer under coordination of benefits (COB).
Suggested Fix / Action
Identify the primary payer, bill them first, then submit to the secondary payer with the primary remittance attached.
Contractual Obligation
Description
Expenses incurred after coverage terminated.
Suggested Fix / Action
Verify the patient's coverage termination date. If incorrect, update eligibility; otherwise bill the patient or the active payer.
Contractual Obligation
Description
The time limit for filing the claim has expired (timely filing).
Suggested Fix / Action
Gather proof of timely submission (clearinghouse reports) and appeal, or write off if no documentation exists. Tighten filing workflows.
Contractual Obligation
Description
Charge exceeds the fee schedule, maximum allowable, or contracted amount. This is a contractual adjustment.
Suggested Fix / Action
No action usually needed — this is the write-off between billed and allowed amounts. Verify the contracted rate is correct.
Contractual Obligation
Description
These services are not deemed a medical necessity by the payer.
Suggested Fix / Action
Confirm the diagnosis supports necessity, attach supporting clinical documentation, and appeal with a medical necessity letter.
Contractual Obligation
Description
Non-covered charge(s). The service is not covered under the patient's plan.
Suggested Fix / Action
Check the remark code for the reason. If non-covered, bill the patient when an ABN/waiver is on file; otherwise verify benefits.
Contractual Obligation
Description
The benefit for this service is included in the payment/allowance for another service already adjudicated (bundling).
Suggested Fix / Action
Review bundling and NCCI edits. If the service is separately payable, append the appropriate modifier (e.g., 59/XU) and appeal.
Contractual Obligation
Description
Claim not covered by this payer/contractor. It must be sent to the correct payer.
Suggested Fix / Action
Verify the patient's correct payer and plan, then submit the claim to the appropriate insurer.
Contractual Obligation
Description
Payment adjusted because the payer deems the information does not support this many/frequency of services.
Suggested Fix / Action
Review frequency limits and documentation. Provide records justifying the volume of services and appeal if appropriate.
Contractual Obligation
Description
The diagnosis is not covered under the patient's plan.
Suggested Fix / Action
Verify the diagnosis code and coverage policy. Correct the diagnosis if miscoded, or bill the patient for non-covered conditions.
Patient Responsibility
Description
Deductible amount. The patient owes this amount toward their annual deductible.
Suggested Fix / Action
Bill the patient for the deductible amount on their statement. No payer action required.
Patient Responsibility
Description
Coinsurance amount. The patient's share of the allowed amount.
Suggested Fix / Action
Bill the patient for the coinsurance after the payer pays its portion. No payer action required.
Patient Responsibility
Description
Copayment amount. The fixed patient responsibility for the visit/service.
Suggested Fix / Action
Collect the copay from the patient — ideally at time of service. Post it as patient responsibility.
Patient Responsibility
Description
Routine/preventive exam or screening procedure done with a routine exam — patient responsibility.
Suggested Fix / Action
Confirm whether the service qualifies as preventive. If patient responsibility applies, bill the patient.
Patient Responsibility
Description
This service/equipment/drug is not covered under the patient's current benefit plan.
Suggested Fix / Action
Verify benefits. If a valid ABN/waiver is on file, bill the patient; otherwise advise the patient of non-coverage.
Other Adjustment
Description
The impact of prior payer(s) adjudication including payments and/or adjustments.
Suggested Fix / Action
Reconcile the primary payer's payment and adjustments before billing the secondary payer. Attach the primary EOB.
Payer Initiated
Description
Service not covered under the plan — adjustment is the payer's initiative, not patient responsibility.
Suggested Fix / Action
Review the plan policy. The balance is typically a write-off rather than patient responsibility unless a waiver exists.
Note: Denial codes (CARC/RARC) and payer policies change over time and vary by contract. Always confirm the exact remark code on your remittance advice and verify current requirements with the payer before acting.