Here you could find Group code and denial reason too.Ĥ The procedure code is inconsistent with the modifier used or a required modifier is missing.ĥ The procedure code/bill type is inconsistent with the place of service.Ħ The procedure/revenue code is inconsistent with the patient's age.ħ The procedure/revenue code is inconsistent with the patient's gender.Ĩ The procedure code is inconsistent with the provider type/specialty (taxonomy).ĩ The diagnosis is inconsistent with the patient's age.ġ0 The diagnosis is inconsistent with the patient's gender.ġ1 The diagnosis is inconsistent with the procedure.ġ2 The diagnosis is inconsistent with the provider type.ġ3 The date of death precedes the date of service.ġ4 The date of birth follows the date of service.ġ5 The authorization number is missing, invalid, or does not apply to the billed services or provider.ġ6 Claim/service lacks information or has submission/billing error(s) which is needed for adjudication.ġ7 Requested information was not provided or was insufficient/incomplete.ġ9 This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.Ģ0 This injury/illness is covered by the liability carrier.Ģ1 This injury/illness is the liability of the no-fault carrier.Ģ2 This care may be covered by another payer per coordination of benefits.Ģ3 The impact of prior payer(s) adjudication including payments and/or adjustments.Ģ4 Charges are covered under a capitation agreement/managed care plan.Ģ5 Payment denied. PR B9 Services not covered because the patient is enrolled in a Hospice. PR 204 This service/equipment/drug is not covered under the patient’s current benefit plan Patient is responsible for amount of this claim/service through WC “Medicare set aside arrangement” or other agreement. PR 201 Workers Compensation case settled. PR 200 Expenses incurred during lapse in coverage PR 177 Payment denied because the patient has not met the required eligibility requirements Benefits are not available under this dental plan PR 168 Payment denied as Service(s) have been considered under the patient's medical plan. PR 166 These services were submitted after this payers responsibility for processing claims under this plan ended. PR 149 Lifetime benefit maximum has been reached for this service/benefit category. PR 140 Patient/Insured health identification number and name do not match This change effective : Patient Interest Adjustment (Use Only Group code PR) PR 35 Lifetime benefit maximum has been reached. PR 32 Our records indicate that this dependent is not an eligible dependent as defined. PR 31 Claim denied as patient cannot be identified as our insured. PR 27 Expenses incurred after coverage terminated. PR 26 Expenses incurred prior to coverage. Your Stop loss deductible has not been met. Member’s plan copayment applied to the allowable benefit PR 2 Coinsurance Amount Member’s plan coinsurance rate applied to allowable benefit PR 1 Deductible Amount Member’s plan deductible applied to the allowable benefit For example PR 45, We could bill patient but for CO 45, its a adjustment and we can't bill the patient. Same denial code can be adjustment as well as patient responsibility. PR - Patient Responsibility - We could bill the patient for this denial however please make sure that any other rejection reason not specified in the EOB.