Denial Code Lookup

Reference list

• CO-4

  The procedure code is inconsistent with the modifier.

  Ask the provider to verify the modifier matches the procedure and resubmit a corrected claim.

• CO-11

  The diagnosis is inconsistent with the procedure.

  Request the provider review the diagnosis-to-procedure linkage and submit a corrected claim.

• CO-16

  Claim lacks information needed for adjudication.

  Identify the missing element on the remittance advice and have the provider resubmit with the required information.

• CO-29

  The time limit for filing has expired.

  Check the payer’s timely filing policy and request a reconsideration if you have proof of earlier submission.

• CO-45

  Charge exceeds fee schedule / maximum allowable.

  This is a contractual write-off — confirm it is not being billed to you as patient responsibility.

• CO-97

  The benefit for this service is included in the payment for another service already adjudicated.

  Verify whether the bundling is correct; if separately billable, request the provider appeal with documentation.

• PR-1

  Deductible amount.

  This is patient responsibility — confirm against your plan’s deductible balance for the year.

• PR-2

  Coinsurance amount.

  This is your share after the plan pays — verify the percentage matches your policy.

• PR-3

  Co-payment amount.

  This is your fixed copay for the visit type — confirm against your plan’s schedule of benefits.

• OA-23

  The impact of prior payer(s) adjudication, including payments and adjustments.

  Cross-check the primary payer’s EOB to confirm the secondary payer applied the correct coordination of benefits.