What does denial code PR 204 mean?
PR-204: This service, equipment and/or drug is not covered under the patient’s current benefit plan.
Is CO 45 responsible for patients?
You will see this amount listed as CO-45. We post an adjustment of $347.44, post a payment of $122.05, and $30.51 is the copay/coinsurance, which is patient responsibility. A bill for that amount was automatically forwarded to the patient’s secondary insurance by Medicare.
What does pr45 mean?
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 denial code PR 177?
PR 177 Payment denied because the patient has not met the required eligibility requirements.
What is F2 denial?
F2. Finalized/Denial-The claim/line has been denied. Start: 01/01/1995. F3. Finalized/Revised – Adjudication information has been changed.
What does pr1 mean on an EOB?
PR 1 Deductible Amount Member’s plan deductible applied to the allowable benefit for the rendered service(s). PR 2 Coinsurance Amount Member’s plan coinsurance rate applied to allowable benefit for the rendered service(s).
What does PR 242 mean?
242. Services not provided by network/primary care providers.
What is OA 27 denial code?
Insurance will deny the claim as Denial Code CO-27 – Expenses incurred after coverage terminated, when patient policy was termed at the time of service. It means provider performed the health care services to the patient after the member insurance policy terminated.
What is OA 23 denial?
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 does PR 3 mean on an EOB?
Description: Copayment A specified dollar amount or percentage of the charge identified that is paid by a beneficiary at the time of service to a health care plan, physician, hospital, or other provider of care for covered service provided to the beneficiary.
What does denial code B13 mean?
B13 Previously paid. Payment for this claim/service may have been provided in a previous payment.
What is denial code co A1?
CO-A1 — Claim/services denied.