1. Claims or service lacks information which is needed for adjudication.
2. Duplicate claim or service.
3. Procedure or treatment is deemed experimental or investigational by the payor.
4. The benefit for this service is not included in the payment or allowance for another service or procedure that has already been adjudicated.
5. These are non-covered services because they are not deemed “medically necessary” by the payor.
6. Pre-certification, authorization or notification is absent.
7. Claims were not covered by the payor or contractor. You must send the claim to the correct payor or contractor.
8. Payment for the claim or service may have been provided in a previous payment.
9. The patient or insured health identification number and name do not match.
10. Coverage or program guidelines were not met or were exceeded.
Learn more about RemitDATA.
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