Denial Resolution Search

OA18

Duplicate service by the same provider on the same date of service

Reconsideration to support payment of duplicate services

Duplicate service by the another provider on the same date of service

Ensure claim is billed with appropriate modifier(s) to indicate duplicate services performed by another provider.

Submit claim correction for any code changes or additions.

Request reconsideration to support payment of duplicate services.

CO4

N657

Service billed with inappropriate modifier or anatomical modifier

Claim correction to change or remove modifier

Service billed with global modifier, but is not within a global period of another procedure

Claim correction to remove modifier

CO16

MA63

Diagnosis to modifier comparison;

Example: RT modifier, but diagnosis states LT

Claim correction to correct modifier or diagnosis

Diagnosis to Diagnosis Comparison;

Example: Pain in Right Elbow, Pain in Unspecified Elbow

Claim correction to remove unspecified diagnosis

Excludes1 Diagnosis; Per ICD-10-CM codes cannot be billed together.

Example: Diagnosis M79.18 (Myalgia, other site) has an Excludes1 for M60.x

Claim correction to remove Excludes1 diagnosis

Secondary diagnosis is the only diagnosis on the claim;

Example: Per ICD-10-CM for diagnosis M10.49 (Other secondary gout, multiple sites) parenthetical notes states to code first the associated condition

Claim correction to add appropriate primary diagnosis

Unacceptable principle diagnosis per ICD-10-CM

Claim correction to add appropriate primary diagnosis

CO96

N56

New patient billed when patient has already received care from the provider

Claim correction to change procedure code to established patient

CO97

N20

NCCI, Mutually Exclusive, modifier present

Request reconsideration with supporting documentation

NCCI, Non-mutually exclusive, modifier present

Request reconsideration with supporting documentation

NCCI, Non-mutually exclusive, no modifier present

If documentation supports, claim correction to add NCCI modifier. If documentation does not support, provider write-off.

CO97

M144

Revenue codes billed without a HCPCS code

Claim correction to add HCPCS code

COB14

M86

Multiple E/M on the same date of service for the same group and same specialty.

Billed service should represent level of service for combined visits.

Submit claim correction for any code changes.

Request reconsideration with supporting documentation if different condition being treated.

Multiple E/M on the same date of service and same revenue code.

Claim correction for any code changes or additions.

Request reconsideration with supporting documentation if different condition being treated.