Denials
October – December 2022, Inpatient Hospital and Psych Medical Review Top Denial Reason Codes
We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing the 11X bill type in Alabama, Georgia and Tennessee.
|
Rank |
Denial Code |
Denial Description |
# Claims |
|---|---|---|---|
|
1 |
Auto Denial — Requested Records Not Submitted |
36 |
|
|
2 |
No Valid Plan of Treatment Present |
2 |
|
|
3 |
Documentation Submitted Does Not Support Medical Necessity for Inpatient Psychiatric Services |
2 |
|
|
4 |
LCD Denial — No Medical Necessity |
1 |
|
|
5 |
No Valid Certification/Recertification Present |
1 |
October – December 2022, Outpatient Services Medical Review Top Denial Reason Codes
We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing the 13X bill type in Alabama, Georgia and Tennessee.
|
Rank |
Denial Code |
Denial Description |
# Claims |
|---|---|---|---|
|
1 |
No Diagnosis/Documentation to Support Medical Necessity (Bene Liable/ Provider Liable) |
5024 |
|
|
2 |
No Medical Necessity |
3699 |
|
|
3 |
Auto Denial — Requested Records Not Submitted |
351 |
|
|
4 |
Documentation Submitted Does Not Support Medical Necessity |
253 |
|
|
5 |
Service Is Subject to Prior Authorization and No UTN Is Present on the Claim |
120 |
|
|
6 |
NCD Denial — HCPCS/Diagnosis Matched National Coverage Determination (NCD) Table List ICD9-CM Deny Codes |
110 |
|
|
7 |
No Certification |
48 |
|
|
8 |
Services Not Documented |
47 |
|
|
9 |
Billing Error for Hospital |
38 |
|
|
10 |
Item of Service Is Subject to Prior Authorization and No Prior Authorization Was Requested for the Item of Service |
36 |
October – December 2022, Skilled Nursing Facility Medical Review Top Denial Reason Codes
We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing the 21X bill type in Alabama, Georgia and Tennessee.
|
Rank |
Denial Code |
Denial Description |
# Claims |
|---|---|---|---|
|
1 |
Agree with Provider (Beneficiary Liable) |
5 |
|
|
2 |
Agree with Provider (Provider Liable) |
4 |
|
|
3 |
LCD Denial — No Medical Necessity |
1 |