The procedure code/ revenue code is inconsistent with the patient's ageĪsk the same questions as denial code - 5, but here need check which procedure code submitted is incompatible with patient's age? (If the procedure code/ bill type is correct with the place of service submitted and if the representative denies to send the claim back for reprocessing, then you have rights to appeal the claim along with medical records.)

Note: Correct and resubmit the claim as corrected claim, if the procedure code or bill type is inconsistent with the place of service. POS: It is the place where the services rendered to patientĢ) Verify whether procedure code is inconsistent with the place of service or bill type is inconsistent with the POS?Ĥ) Get the appeals information/ correct claims address/ TFL to submit corrected claim (If the modifier submitted is correct and if the representative denies to send the claim back for reprocessing, then you have rights to appeal the claim along with medical records.)ĭenial Code - 5 is 'Px code/ bill type is inconsistent with the POS' Correct the modifier and resubmit the claim as corrected claim. Note: If the modifier is inconsistent with procedure code or modifier missing.

Let us see some of the important denial codes in medical billing with solutions: Denial Codesĭenial Codes / Remit Codes Description in Medical Billingĭenial Codes in Medical Billing / Remit Codes -Solutions or Questions need to ask with Insurance representative.Ģ) Get the allowed amount and the amount that was applied towards the patient's deductible?ģ) Get the payment details if there was any?Ĥ) Get the patient's calendar year/lifetime deductible and how much of it has been met? (Note: If annual deductible is already met, reprocess the claim)ĥ) Get if the claim is processed towards in network or out of network deductible and how much deductible?Ħ) Get the Claim number and Calreference number?Ĭoinsurance: Percentage or amount defined in the insurance plan for which the patient is responsible.Ģ) Get the allowed amount, paid details if any and the amount that was applied towards the patient's Coinsurance?ģ) Get the Claim number and Calreference number?Ģ) Get the allowed amount, paid details if any and the amount that was applied towards the patient's Copayment?ĭescription for Denial code - 4 is as follows 'The px code is inconsistent with the modifier used or a required modifier is missing'.Ģ) Verify whether modifier is inconsistent with procedure code or modifier missing?ģ) Send for reprocess and collect the follow up date, if the denial is incorrectĤ) Get the appeals information/ corrected claims address/ TFL to submit corrected claimĥ) Get the Claim number and Calreference number

Other words for denied