Tuesday, May 25, 2010

Insurance denial - Some basic terms which we need to know

Reason Codes

• Provide information about claim decisions
• Tells why a claim was paid differently than it was billed
• CO, PR

Remark Codes

• Numerical codes that further explain the denial
• Indicate if/what appeal rights apply
• B, M, MOA, and N

CO: Contractual Obligation
• Patient cannot be billed
• Provider filing error
• Provider must correct and file a new claim

PR: Patient Responsibility

• Patient can be billed

What should you do when you get a denial?

• Do you file a new claim?
• Request an appeal?
o How to resolve and avoid future denials

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