A denial code usually accompanies the denial of claims for failing to fulfil specific requirements the insurance company sets.
Modifier 57 is a crucial billing modifier used to indicate the decision for surgery made on the day of or the day before a major procedure. This modifier ensures proper reimbursement for an evaluation and management (E/M) service that directly leads to a surgical procedure. What is Modifier 57? Modifier 57 is applied when a … Read more
Medical billing is a complex process that involves submitting claims to insurance companies to receive reimbursement for healthcare services. However, claim denials are common, and one of the most frequent denial codes encountered by medical billers is Denial Code 16. Understanding what this denial means, how to resolve it, and ways to prevent it in … Read more
Whether you’re a medical biller, coding student, or healthcare provider, understanding commonly used ICDs in medical billing is essential. ICD codes (short for International Classification of Diseases) are the foundation of diagnosis coding and crucial for accurate billing, claim processing, and compliance. But with over 70,000+ ICD-10-CM codes, how do you know which ones are … Read more
When you file an insurance claim, especially for medical procedures or hospital visits, you expect it to be handled fairly and promptly. But then—out of nowhere—a denial letter lands in your mailbox. Confused? Frustrated? You’re not alone. Understanding why insurance denied the claim is critical, not just for resolving the issue at hand, but also … Read more
Denial Code 18 signifies that the insurance payer has rejected the claim because it appears to be a duplicate submission. This occurs when a provider submits the same claim multiple times, whether intentionally or unintentionally, before the original claim has been fully processed. Common Causes of Denial Code 18 Several factors contribute to Denial Code … Read more
What is Denial Code CO 27? Denial Code 27 in medical billing refers to “Expenses incurred after coverage terminated”. This means that the claim was denied because the services were provided after the patient’s insurance coverage had expired or was no longer active. Common Causes of Denial Code 27 How to Fix Denial Code CO … Read more
What is Denial Code 22? Denial Code 22 in medical billing refers to “This care may be covered by another payer per coordination of benefits (COB).” This denial occurs when the insurance payer determines that another insurer should be the primary payer, leading to claim rejection or a delay in reimbursement. Common Causes of Denial … Read more
What is Denial Code 29? Denial Code 29 in medical billing indicates “The time limit for filing has expired.” This means that the claim was submitted after the payer’s allowable timeframe for claim submission, resulting in denial. Every insurance payer, including Medicare, Medicaid, and commercial insurers, has a specific timeframe within which claims must be … Read more
Understanding Denial Code 7 (CO-7): Procedure Inconsistent with Patient’s Gender In medical billing, Denial Code 7, also known as CO-7, means that the procedure or revenue code submitted on a claim is inconsistent with the patient’s gender as listed in their records. This can lead to a claim denial from insurance payers, including Medicare and … Read more
A copay is a fixed amount that a patient is required to pay for a specific medical service or prescription, at the time the service is provided. It is denoted as copay (PR-3) This amount is typically predetermined by the patient’s health insurance plan and does not change based on the total cost of the … Read more
