What is denial code PR 26?

Asked By: Ayob Villegas | Last Updated: 1st February, 2020
Category: personal finance health insurance
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Denial Reason, Reason/Remark Code(s)
PR-26: Expenses incurred prior to coverage. PR-27: Expenses incurred after coverage terminated. • Claim Adjustment Reason Code (CARC) 26: Expenses incurred prior to coverage.

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Hereof, what does OA 23 denial mean?

Claim Adjustment Reason Codes are associated with an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. OA-23 indicates the impact of prior payer(s) adjudication, including payments and/or adjustments.

Similarly, what does PR 187 mean? 186 Level of care change adjustment. 187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.) 188 This product/procedure is only covered when used according to FDA recommendations.

Regarding this, what does PR 96 mean?

Whenever claim denied as CO 96 – Non Covered Charges it may be because of following reasons: Diagnosis or service (CPT) performed or billed are not covered based on the LCD. Services not covered due to patient current benefit plan.

What does PR 204 mean?

PR-204: This service/equipment/drug is not covered under the patient's current benefit plan.

28 Related Question Answers Found

Is OA 23 patient responsibility?

OA (Other Adjustments): is used when no other group code applies to the adjustment. PI (Payer Initiated Reductions): is used by payers when it is believed the adjustment is not the responsibility of the patient but there is no supporting contract between the provider and payer.

What does code 23 mean?

Infectious disease

What does OA 121 mean?

A4: OA-121 has to do with an outstanding balance owed by the patient.

What is denial code Co 97?

It means the Evaluation and management services that are related to the surgery performed during the post-operative period will be denied as CO 97 – The benefit for this service is included in the payment or allowance for another service or procedure that has already been adjudicated.

What is denial code co16?


The CO16 denial code alerts you that there is information that is missing in order for Medicare to process the claim. Due to the CO (Contractual Obligation) Group Code, the omitted information is the responsibility of the provider and, therefore, the patient cannot be billed for these claims.

What are denial codes?

Denial reason codes is standard messages, which are used to describe or provide information to the medical provider or patient by insurance companies regarding why the claims were denied. This standard format is followed by all the insurance companies in order to relieve the burden of the medical provider.

What does denial code a1 mean?

At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) A1 - Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

What are ANSI codes?

American National Standards Institute codes (ANSI codes) are standardized numeric or alphabetic codes issued by the American National Standards Institute (ANSI) to ensure uniform identification of geographic entities through all federal government agencies.

What does PR 27 mean?

PR-27: Expenses incurred after coverage terminated. • Claim Adjustment Reason Code (CARC) 26: Expenses incurred prior to coverage.

What are reasons codes?


Reason codes, also called score factors or adverse action codes, are numerical or word-based codes that describe the reasons why a particular credit score is not higher. For example, a code might cite a high utilization rate of available credit as the main negative influence on a particular credit score.

What is a major medical adjustment?

noun. insurance designed to compensate for particularly large medical expenses due to a severe or prolonged illness, usually by paying a high percentage of medical bills above a certain amount.

What does PR 227 mean?

227: Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

What does OA 94 mean?

94. Page 6. CO = Contractual obligation. OA = Other adjustment. PI = Payer-initiated reductions.

What is a remark code?

Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. There are two types of RARCs, supplemental and informational.

What is claim level cob?


The most common COB provision, also referred to as “COB method”, is standard COB. With standard COB, the total amount paid by two or more health plans will not exceed 100% of the total allowable expense. Essentially, the total amount paid between both plans should not exceed 100% of the total allowable expense.

What is co45?

May 25th, 2012 - re: what is the meaning of CO-45 : Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. It means it is the facility's contractual obiligation and patient can not be billed for that amount. It should be adjusted off the patient's bill.

What is Medicare adjustment code CO 237?

CO-237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) This is E-prescribing and PQRS. N699 – Payment adjusted based on the PQRS Incentive Program.