BCBS Denial Codes List and How to Reduce Them

Dealing with BCBS denial codes can be frustrating and time-consuming, but understanding how to reduce them can make a huge difference. One way to minimize denials is to review and correct claims before submission.

BCBS has a long list of denial codes, with over 20,000 codes to keep track of. This can be overwhelming, but knowing the most common codes can help you prepare.

To reduce denials, it's essential to ensure accurate patient information and demographics. This includes verifying patient names, dates of birth, and insurance information.

Understanding BCBS Denial Codes starts with knowing what to do when you receive a denial notice. The notice typically includes specific remark codes outlining the issues.

If the denial is due to incomplete or inaccurate information, the provider is responsible for fixing and resubmitting the claim per contractual requirements. This involves identifying the errors or missing details, correcting them, and resubmitting the updated claim.

The sheer volume and intricacy of denial codes can be daunting, often resulting in errors and inefficiencies when manually handled. CO-29 Code denotes that the time limit for filing has expired.

CO-104 Code indicates that the claim was processed according to a contractual agreement or legislation. CO-9 Code signals that the diagnosis is inconsistent with the patient's gender.

Rejections often occur due to incomplete or inaccurate information in the claim submission.

The provider is tasked with fixing and resubmitting the claim per contractual requirements.

Missing purchase details for diagnostic tests can lead to a denial, indicated by remark code M12.

A claim for a wheelchair may be denied if it lacks an updated Certificate of Medical Necessity (CMN).

The ordering provider's name is missing or incorrect, as seen with remark code N264.

A mismatch between the submitted provider name and records can cause a denial, noted by remark code N575.

Missing information on patient's equipment ownership can result in a denial, shown by remark code M124.

Here are some common remark codes for CO-16 denial, along with their descriptions:

Insurance and coverage issues can be a real challenge. CO-167 Diagnosis Not Covered is a common denial code that indicates the coverage provider doesn't cover the indicated service. Look closely at the patient's history to ensure the proper diagnostic codes are in place.

Insurance and coverage can expire for various reasons, such as the patient becoming ineligible or the program's requirements changing. CO-27 Insurance or Coverage Expired is a denial code that can be prevented by pre-verifying coverage before the patient attends their appointment.

Manual handling of insurance and coverage issues can lead to errors, but understanding the denial codes can help. CO, PR, and CR codes denote contractual agreements, patient responsibility, and corrections and reversals, respectively. These codes are crucial to resolving insurance and coverage issues efficiently.

The CO-22 Coordination of Benefits Error is a common issue that can arise when dealing with insurance claims. It typically occurs when the payment source believes the service is, or should be, covered by another source.

This error requires an investigation to understand the full scope of the patient's care and coverage. It's essential to review the claim and gather all necessary information to resolve the issue.

If you're dealing with a CO-22 error, it's crucial to understand that these denial codes indicate an investigation is needed. This means you'll need to provide additional documentation or information to support the claim.

Here are some key points to keep in mind when dealing with a CO-22 error:

By understanding the CO-22 Coordination of Benefits Error and taking the necessary steps to resolve it, you can help ensure that patients receive the coverage they need.

CO-27 Expired Insurance/Coverage is a common denial code that can be frustrating for patients and providers alike. It's essential to understand the reasons behind this code to prevent it from happening in the first place.

Pre-verifying coverage before a patient attends their appointment can help prevent CO-27 denials. This simple step can save time and effort in the long run.

Government payment sources like Medicare and Medicaid provide denial codes when claims are rejected or denied, including CO-27. Insurance companies also use these codes, but FQHCs often have a high proportion of patients using Medicare and Medicaid.

To address CO-27 denials, healthcare providers must understand the reasons behind them. In some cases, the patient may become ineligible for coverage, or the program's requirements may have changed.

Here are some common reasons for CO-27 denials:

By understanding the reasons behind CO-27 denials and taking proactive steps to prevent them, healthcare providers can improve patient satisfaction and reduce administrative burdens.

If a patient's claim is denied due to a diagnosis not being covered, take a closer look at their medical history. This includes the services your clinic provided and whether the proper diagnostic codes are in place.

A denial code like CO-167 indicates that the coverage provider does not cover the indicated service. This code is a signal to investigate further and ensure that all necessary information is included.

Government payment sources like Medicare and Medicaid provide denial codes when claims are rejected or denied. Insurance companies also use these codes, although most Federally Qualified Health Centers (FQHCs) have a high proportion of patients using Medicare and Medicaid.

To address claims denied due to missing information, review the patient's file and ensure that all necessary details are included. This might involve updating the patient's medical history or adding additional documentation to support the claim.

In some cases, a diagnosis not being covered may be due to a lack of compelling evidence that the service should be covered. This can be a complex issue to resolve, but it's essential to address it to ensure the patient receives the necessary care.

Here are some common reasons for denial codes related to diagnosis not being covered:

Denial codes are used in electronic health records (EHRs) and are the nationwide standard in U.S. healthcare.

Government payment sources like Medicare and Medicaid provide denial codes when claims are rejected or denied. Insurance companies use these codes too, although most FQHCs have a high proportion of patients using Medicare and Medicaid.

Healthcare providers use denial codes to understand why claims haven’t been paid and address remaining issues.

You may be able to submit additional information or make a correction and appeal the decision if a denial code doesn’t necessarily indicate a final decision.

The provider is tasked with fixing and resubmitting the claim per contractual requirements if the denial cause is rejection due to incomplete or inaccurate information.

The denial notice typically includes specific remark codes outlining the issues, so you can identify the errors or missing details and correct them.

You should consult the insurer if the denial notice doesn’t include specific remark codes outlining the issues.

If you're dealing with a CO-16 denial code, it's likely due to incomplete or inaccurate information in the claim submission.

The provider is responsible for fixing and resubmitting the claim per contractual requirements. This means they need to identify the errors or missing details, correct them, and resubmit the updated claim.

A CO-16 denial notice typically includes specific remark codes outlining the issues. If you're missing these codes, consult the insurer to get the information you need.

To give you a better idea of what these remark codes look like, here's a list of common ones:

By understanding these remark codes, you can take the necessary steps to correct the issues and resubmit the claim.

Denial codes are a crucial part of medical billing, and understanding them can help healthcare providers and payment sources resolve issues quickly.

Government payment sources like Medicare and Medicaid provide denial codes when claims are rejected or denied, which helps providers understand why claims haven't been paid.

Healthcare providers use denial codes to identify and fix errors or missing details in claims submissions.

The CO 16 denial code is a common reason for claim rejections, occurring due to incomplete or inaccurate information in the claim submission.

To reduce CO 16 denials, providers should check claim details carefully before submission, ensuring all information is correct.

Using claim review software can also help spot errors and missing details, reducing the likelihood of common issues.

Regular training for billing and coding staff is essential to keep them updated on the latest procedures and reduce mistakes.

Submitting claims electronically can also help reduce errors and improve processing times.

Regular audits of claims can help identify and fix issues that could cause denials, reducing the number of rejections.

Here are some effective approaches to reduce CO 16 denials:

Government payment sources like Medicare and Medicaid provide denial codes when claims are rejected or denied. These codes are crucial for healthcare providers to understand why claims haven't been paid and address remaining issues.

Insurance companies use denial codes too, although most FQHCs have a high proportion of patients using Medicare and Medicaid. Understanding these codes and acting accordingly is vital to avoid errors in the billing process.

Healthcare providers can discover claims have been denied due to simple things, like missing information, or more complex reasons, like a lack of compelling evidence that the service should be covered.

Here are some common remark codes for CO-16 denial:

Denial codes don't necessarily indicate a final decision. You may be able to submit additional information or make a correction and appeal the decision.

Government payment sources like Medicare and Medicaid provide denial codes when claims are rejected or denied, but this doesn't mean it's the end of the road.

Healthcare providers use denial codes to understand why claims haven’t been paid, and if it's due to missing information, you can address the issue and resubmit the claim.

Insurance companies use denial codes too, but most Federally Qualified Health Centers (FQHCs) have a high proportion of patients using Medicare and Medicaid, which can simplify the process.

You may be able to collect the payment if you can provide the necessary information or make the required corrections, so don't give up if your claim is denied.

The CO 16 denial code is a good example of how important it is to have accurate information in a claim submission.

Rejection due to incomplete or inaccurate information in the claim submission is a common reason for denial.

To fix this, the provider needs to identify the errors or missing details, correct them, and resubmit the updated claim.

Consulting the insurer is a good idea if the denial notice doesn't include specific remark codes outlining the issues.

Here's a breakdown of the main types of denial codes: