What is the duplicate denial code?
Asked by: Era Larkin | Last update: June 22, 2025Score: 4.7/5 (73 votes)
What is CO 242 denial code?
What is Denial Code 242. Denial code 242 means that the services being claimed were not provided by network or primary care providers. This indicates that the healthcare service or procedure was performed by a provider who is not part of the patient's designated network or primary care provider.
What is a 177 denial?
Denial code 177 is indicative of the patient not meeting the necessary eligibility requirements. This means that the patient does not fulfill the criteria set by the insurance company or the healthcare provider to receive the specific healthcare service or treatment. As a result, the claim for reimbursement is denied.
What is denial code co 167?
Denial code 167 means the diagnosis is not covered. Check the 835 Healthcare Policy Identification Segment for more information.
What is denial code co 18?
CO 18 denial code specifically indicates that the billed services or procedures are not medically necessary or are not considered appropriate treatment based on medical standards. Insurance companies use this code to convey that the provided services are not supported by medical documentation or guidelines.
DUPLICATE DENIAL (DENIAL CODE 18) - [denial management] in medical billing
What is CO 197 denial?
What is Denial Code 197. Denial code 197 means that the precertification, authorization, notification, or pre-treatment requirement was not fulfilled or was absent.
What is denial code co 28?
28 Coverage not in effect at the time the service was provided. 29 The time limit for filing has expired. 30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.
What is denial code co 133?
What is Denial Code 133. Denial code 133 is used when the disposition of a service line is pending further review. This code should only be used with Group Code OA. When this code is used, it indicates that a reversal and correction is required once the service line is finalized.
What is denial code co 129?
CO 129 Payment denied – prior processing information incorrect.
What is denial code co 261?
Denial code 261 is used when the procedure or service being billed is not consistent with the patient's medical history. This means that the insurance company is denying the claim because they believe that the treatment or service provided is not necessary or appropriate based on the patient's past medical records.
What is denial code co 182?
What is Denial Code 182. Denial code 182 is indicating that the procedure modifier used on the date of service was invalid. This means that the modifier code attached to a specific procedure code was either incorrect or not recognized by the payer.
What is a 243 denial code?
Denial code 243 is used to indicate that the services being billed were not authorized by the network or primary care providers. This means that the healthcare provider did not obtain the necessary approval or referral from the patient's insurance network or primary care physician before providing the services.
What is a 223 denial code?
What is Denial Code 223. Denial code 223 is used when there is an adjustment required due to a federal, state, or local law/regulation that is not covered by any other existing code. This denial code indicates that the adjustment is mandated and must be addressed before a new code can be created.
What is co 131 denial code?
Denial code 131 means that the claim has been denied because it is requesting a specific negotiated discount that is not allowed according to the terms of the agreement between the healthcare provider and the payer.
Is Co 45 a denial code?
Denial code CO-45 is a standard message that provides information about a claim that an insurance company cannot accept. It is an example of a claim adjustment reason code (CARC) used to communicate the reason for a denial or a reduced payment.
What is denial code co 144?
What is Denial Code 144. Denial code 144 is related to an incentive adjustment, such as a preferred product or service. This means that the claim has been denied because the insurance company or payer does not cover or provide additional benefits for the specific product or service that was billed.
What is CO 97 denial?
What is the CO 97 Denial Code? The CO 97 Denial Code plays a crucial role in medical billing, signaling that a service or procedure isn't eligible for separate payment. Essentially, the benefit for a given service or procedure is already included in the payment for another previously adjudicated procedure or service.
What is denial code co 104?
What is Denial Code 104. Denial code 104 is related to managed care withholding. This means that the insurance company or managed care organization is withholding payment for the claim due to certain reasons or discrepancies.
What is denial code co 234?
The Specifics of CO 234 Denial Code
Co 234 indicates that the procedure or service provided is included in the pre-operative or post-operative period of another procedure. In simpler terms, it means that the billed service is considered a part of a larger procedure and should not be separately reimbursed.
What is co 27 denial code?
What is the CO 27 Denial Code? The CO 27 Denial Code signals that health care services were provided to a patient after the termination of their insurance policy. Digging deeper into the framework of medical billing, it's evident that services need to be rendered while a patient's insurance is still active.
What is denial code co 236?
What is Denial Code 236. Denial code 236 is used when a procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day.
What is CO 252 denial?
What is Denial Code 252. Denial code 252 is used when an attachment or other documentation is required in order to process and approve a claim or service.
What is co 50 denial code?
CO 50, the sixth most frequent reason for Medicare claim denials, is defined as: “non-covered services because this is not deemed a 'medical necessity' by the payer.” When this denial is received, it means Medicare does not consider the item that was billed as medically necessary for the patient.
What is denial code co 106?
Denial code 106 means that the patient's chosen payment option or election is not currently in effect. This could indicate that the patient has not made a payment arrangement or has not selected a specific payment method for their healthcare services. As a result, the claim for reimbursement has been denied.
What is a co 32 denial code?
The CO 32 denial code signifies that the patient's records indicate they are not an eligible dependent. This means the claim for the patient's healthcare services has been denied due to the patient's dependent status not meeting the criteria set by the insurance plan.