For details on known specific payer denials see this article.
| Denial Adjustment Code | Description |
| 2 | Coinsurance Amount |
| 3 | Co-payment Amount |
| 8 | The procedure code is inconsistent with the provider type/specialty (taxonomy). |
| 9 | The diagnosis is inconsistent with the patient's age. |
| 16 | Claim/service lacks information or has submission/billing error(s). |
| 18 | Exact duplicate claim/service |
| 21 | This injury/illness is the liability of the no-fault carrier. |
| 22 | This care may be covered by another payer per coordination of benefits. |
| 23 | The impact of prior payer(s) adjudication including payments and/or adjustments. |
| 24 | Charges are covered under a capitation agreement/managed care plan. |
| 26 | Expenses incurred prior to coverage. |
| 27 | Expenses incurred after coverage terminated. |
| 29 | The time limit for filing has expired. |
| 31 | Patient cannot be identified as our insured. |
| 32 | Our records indicate the patient is not an eligible dependent. |
| 45 | Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. |
| 58 | Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. |
| 95 | Plan procedures not followed. |
| 96 | Non-covered charge(s). At least one Remark Code must be provided |
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. |
| 102 | Major Medical Adjustment. |
| 109 | Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor. |
| 119 | Benefit maximum for this time period or occurrence has been reached. |
| 125 | Submission/billing error(s). At least one Remark Code must be provided |
| 133 | The disposition of this service line is pending further review. |
| 136 | Failure to follow prior payer's coverage rules. |
| 147 | Provider contracted/negotiated rate expired or not on file. |
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. |
| 164 | Attachment/other documentation referenced on the claim was not received in a timely fashion. |
| 171 | Payment is denied when performed/billed by this type of provider in this type of facility. |
| 177 | Patient has not met the required eligibility requirements. |
| 197 | Precertification/authorization/notification/pre-treatment absent. |
| 200 | Expenses incurred during lapse in coverage |
| 204 | This service/equipment/drug is not covered under the patient’s current benefit plan |
| 206 | National Provider Identifier - missing. |
| 234 | This procedure is not paid separately. At least one Remark Code must be provided |
| 242 | Services not provided by network/primary care providers. |
| 243 | Services not authorized by network/primary care providers. |
| 252 | An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided |
| 256 | Service not payable per managed care contract. |
| 284 | Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services. |
| 300 | Claim received by the Medical Plan, but benefits not available under this plan. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration. |
| A1 | Claim/Service denied. At least one Remark Code must be provided |
| B1 | Non-covered visits. |
| B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. |
| P16 | Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers' Compensation only. (Use with Group Code CO or OA) |