Denial code CO 45: Charges exceed your contracted/legislated fee arrangement. Kindly 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.
What does code 45 mean in a hospital?
Description. Reason Code: 45. Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
What is PR 45 in medical billing?
For example a PR-45 defines a balance after the insurance payment or adjustment that exceeds the allowed payment from the insurance carrier and assigns that balance as the patient’s responsibility.
What is OA 45 Adjustment code?
45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). 46 This (these) service(s) is (are) not covered.
What does co denial code mean?
What does the denial code CO mean? CO Meaning: Contractual Obligation (provider is financially liable).
What is code GREY in hospital?
A Code Grey is activated if the hospital experiences loss of utilities, such as power, telecommunications, sanitary sewage discharge, potable water, or closure of fresh air intakes, resulting in the potential loss of use of hospital facilities.
Does code blue mean death?
Code Blue is essentially a euphemism for being dead. While it technically means “medical emergency,” it has come to mean that someone in the hospital has a heart that has stopped beating. … Even with perfect CPR, in-hospital cardiac arrests have a roughly 85 percent mortality.
What does PR 204 mean?
Denial Reason, Reason and Remark Code
PR-204: This service, equipment and/or drug is not covered under the patient’s current benefit plan.
What does PR 96 mean?
When a patient meets and undergoes treatment from an Out-of-Network provider. Based on Provider’s consent bill patient either for the whole billed amount or the carrier’s allowable.
What is denial code Co 97?
Denial Code CO 97 ” Procedure or Service Isn’t Paid for Separately. Denial Code CO 97 occurs because the benefit for the service or procedure is included in the allowance or payment for another procedure or service that has already been adjudicated. Basically, the procedure or service is not paid for separately.
What does OA 121 mean?
Q4: What does the denial code OA-121 mean? A4: OA-121 has to do with an outstanding balance owed by the patient.
What does denial code OA 23 mean?
OA-23: Indicates the impact of prior payers(s) adjudication, including payments and/or adjustments. No action required since the amount listed as OA-23 is the allowed amount by the primary payer. OA-109: Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
What is denial code Co 59?
CO 59 ” Processed based on multiple or concurrent procedure rules. Reason and action: This is Multiple surgeries detected, hence confirm with coding guideliness and take the necessity action. Like…to be written off or to bill with appropriate modifier.
How do you fix CO 45 denial?
Denial code CO 45: Charges exceed your contracted/legislated fee arrangement. Kindly 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.
What does denial code Co 151 mean?
Description. Reason Code: 151. Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
What is denial code co109?
Co 109 denial code means Claim or Service not covered by this payer or contractor, you may send it to another payer or covered by another payer.