[PDF] Denial Codes Found on Explanations of Payment/Remittance

What are the denial codes for electronic explanations of payment?

Electronic Explanations of Payment will use standard HIPAA denial codes. EX Code Description 18 DENY: DUPLICATE CLAIM SERVICE 28 DENY: COVERAGE NOT IN EFFECT WHEN SERVICE PROVIDED 29 DENY: THE TIME LIMIT FOR FILING HAS EXPIRED 46 DENY: THIS SERVICE IS NOT COVERED 0B

What is PCN code?

PCN is the abbreviation for Processor Control Number. The use of this code in simple language is defined as finding out which processor will deal with the claim of the user. It also identifies the route of pharmaceutical transactions and finds out the connection with the insurance claims that cover the prescription of the user.

What is a p-code PRN?

This is a form of Code Division Multiple Access (CDMA), which allows the receiver to recognize multiple satellites on the same frequency. The P-code is also a PRN, however each satellite’s P-code PRN code is 6.1871 × 10 12 bits long (6,187,100,000,000 bits) and only repeats once a week (it is transmitted at 10.23 Mbit/s).

What happens if no code is listed in a denial?

If no specific codes are listed in the denial, only the DRG, AP-DRG, or SOI changed, then utilize a coder or CDI professional with access to the encoder to determine which specific code (s) are affecting the billed reimbursement. An ideal multi-disciplinary team includes nurses, CDI staff, coders, physicians, and revenue cycle staff.