By reason
CAS group and CARC. Write-offs excluded — they are not denials.
| Code | Reason | Claims | Denied |
|---|---|---|---|
| PI/27 | Expenses incurred after coverage terminated. | 4,020 | 1,738,436.15 |
| PI/26 | Expenses incurred prior to coverage. | 1,875 | 849,079.18 |
| PI/29 | The time limit for filing has expired. | 1,345 | 597,375.62 |
| PI/197 | Precertification/authorization/notification/pre-treatment absent. | 1,177 | 406,422.80 |
| OA/18 | Exact duplicate claim/service (Use only with Group Code OA except where state wo | 731 | 364,296.00 |
| PI/16 | Claim/service lacks information or has submission/billing error(s). Usage: Do no | 929 | 326,588.34 |
| PI/11 | The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Health | 658 | 234,070.01 |
| PI/18 | Exact duplicate claim/service (Use only with Group Code OA except where state wo | 459 | 171,911.40 |
| PI/96 | Non-covered charge(s). At least one Remark Code must be provided (may be compris | 383 | 136,024.22 |
| PI/50 | These are non-covered services because this is not deemed a 'medical necessity' | 366 | 129,226.52 |
| PI/109 | Claim/service not covered by this payer/contractor. You must send the claim/serv | 249 | 87,948.54 |
| Total | 12,192 | 5,041,378.78 |