Blog
Denial Management
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PR-1 Code: Deductible Amount (What It Means and Who Pays)
What PR-1 means, why it is a patient balance rather than a denial, when secondary insurance pays first, and how to collect deductibles.
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CO-97 Denial Code: Service Included in Another Payment (Bundling)
What CO-97 means, how NCCI bundling edits cause it, when a modifier such as 25 or 59 is justified, and when the adjustment is simply correct.
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CO-197 Denial Code: Prior Authorization Absent (Meaning and Fix)
What CO-197 means, why claims are denied for missing authorization even when one exists, and how to fix, appeal or prevent it.
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CO-50 Denial Code: Not Medically Necessary (Meaning and Appeal)
What CO-50 means, how coverage policies and diagnosis codes drive it, when an ABN shifts liability, and how to build an appeal.
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CO-4 Denial Code: Procedure Code Inconsistent With Modifier
What CO-4 means, the modifier mistakes that cause it, such as laterality, 26/TC and modifier 25, and how to correct the claim.
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CO-16 Denial Code: Claim Lacks Information (Meaning and Fix)
What CO-16 means, why it always comes with a remark code, the most common causes and how to correct and resubmit the claim.
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“Claim Submitted to Incorrect Payer” Rejection: How to Fix It
Why claims are rejected as “Claim submitted to incorrect payer” (status 116), the usual causes and how to route the claim correctly.
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“Entity’s Tax ID” Claim Rejection: How to Fix It
What the “Entity’s tax id” rejection (status 128) means, why the tax ID and NPI must match enrollment, and how to correct the claim.
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“Entity’s Specialty/Taxonomy Code” Claim Rejection: How to Fix It
What the “Entity’s specialty/taxonomy code” rejection (status 145) means, where taxonomy goes on the claim, and how to fix it.
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“Submitter Not Approved for Electronic Claim Submissions” Rejection: How to Fix It
What the “Submitter not approved for electronic claim submissions on behalf of this entity” rejection (status 496) means and how to fix EDI enrollment.
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Tell us what’s getting stuck. Denials, old A/R, credentialing, reports nobody reads? We’ll look at how you work now and tell you straight what we’d change, and why.