What is Co 231 denial code?

Current claim falls within the history claim date range.

What is denial code CO 236?

CO-236: This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination that was provided on the same day according to the National Correct Coding Initiative (NCCI) or workers compensation state regulations/fee schedule requirements.

What does PR 45 denial code mean?

PR 45 – Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Note: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication.

Are there multiple denial reason codes and statements for Medicare?

Historically, Medicare review contractors (Medicare Administrative Contractors, Recovery Audit Contractors and the Supplemental Medical Review Contractor) developed and maintained individual lists of denial reason codes and statements. If you deal with multiple CMS contractors, understanding the many denial codes and statements can be hard.

What is the reason code for denial of pre certification?

Reason Code 59: Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. Reason Code 60: Correction to a prior claim. Reason Code 61: Denial reversed per Medical Review. Reason Code 62: Procedure code was incorrect. This payment reflects the correct code.

What does CARC 223 stand for?

The Centers for Medicare & Medicaid services (CMS) previously assigned CARC 223 (Adjustment code for mandated Federal, State or Local law/regulation that is not already covered by another code and is mandated before a new code can be created) to explain the adjustment in payment.

What happens if my claim is denied/non-affirmed?

CMS contractors medically review some claims (and prior authorizations) to ensure that payment is billed (or authorization requested) only for services that meet all Medicare rules. If the review results in a denied/non-affirmed decision, the review contractor provides a detailed denial/non-affirmed reason to the provider/supplier.