Denial Reason Codes is standard messages, which are used to describe or provide information to the Medical provider or patient by insurances regarding why the claim was denied. This standard format is followed by all the insurances in order to relieve the burden of the Medical provider.
Denial Reason codes and Solutions
These are some of the important Denial reason codes which we come across regularly and it’s been explained with solutions.
You can find complete list of denial codes here: Medicare Denial Reason Codes.
Once the claim has been adjudicated from the insurance company, they will send the remittance or EOB to Medical provider/Patient/Medical Billing Company. If suppose the claim is denied, the EOB or remittance contains denial reason codes which explains how claim was processed.
Provider or Medical Billing Company identifies the exact reason of the denied claim from the Denial reason code which is displayed on the Explanation of Benefits (EOB) or remittance issued from the insurance company, and then find the solutions to reimburse the claims towards payment. Sometimes Provider or Medical billing company may probably contact claims department for more information on the denial reason codes or to know the exact reason of the denial to take necessary actions.