Denial codes, explained
Your Explanation of Benefits uses claim adjustment codes like CO-50 or PR-204. The letters say who's responsible; the number says why. Find yours below, or paste the whole reason into the Denial Decoder.
Denials
50Denied as not medically necessary197Denied for missing prior authorization242Denied as out of network29Denied because the claim was filed late16Denied for missing information or a billing error4Denied for a procedure-code modifier problem11Denied because the diagnosis doesn't match the procedure18Denied as a duplicate claim97Denied as bundled into another service234Denied: not paid separately22Denied: another insurer may be primary109Sent to the wrong insurer27Denied: coverage had ended55Denied as experimental or investigational96Denied as a non-covered charge204Not covered under your benefit plan167Diagnosis not covered119Benefit limit reached151Denied for too many services252More documentation needed
Cost-sharing and adjustments
Code meanings paraphrase the X12 Claim Adjustment Reason Code list (x12.org).