An AR scenario refers to a situation that describes the status, challenges, or follow-up actions related to outstanding claims and payments due from insurance companies or patients. It highlights how a billing team handles unpaid claims, denials, rejections, and delayed reimbursements to ensure proper revenue cycle management
What is CO 197? The CO 197 denial code stands for “Precertification/authorization/notification is missing.” In simple words — before doing certain medical procedures or services, the provider must get approval from the insurance company. If that approval isn’t received (or is wrong or expired), the claim will be denied with CO 197. Example A doctor…
What is CO 50 Mean? The CO 50 denial stands for “These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.” It is used when an insurance company determines that the billed service or procedure does not meet medical necessity criteria. This means the treatment or test provided is not…
What is CO 22 Mean? The CO 22 denial stands for “This care may be covered by another payer per coordination of benefits.” It indicates that the claim has been denied because another insurance payer may be responsible for the payment. This typically happens when the patient has multiple insurance coverages, and the Coordination of…
What is CO 16 Mean? The CO 16 denial stands for “Claim/service lacks information needed for adjudication or has inconsistent information.” Simply put, this denial occurs when the insurance payer cannot process a claim because of some missing details or includes conflicting data — such as patient demographics, diagnosis codes, provider identifiers, or required documentation….
What is CO 11 Mean? The CO 11 denial code stands for “The diagnosis is inconsistent with the procedure.” It is triggered when the payer determines that the diagnosis reported does not validate the necessity of the procedure. In such cases, the claim may be denied or returned for correction, leading to delayed reimbursement and…
What is CO 7 Mean? Claim Adjustment Code (CARC) 7, also known as CO 7, means that the Procedure/Revenue Code is Inconsistent with Patient’s Gender. The CO 7 denial code occurs when the procedure or revenue code billed is not compatible with the patient’s gender as recorded in the system. In simple terms, it means a…
What is CO 6 Mean? Claim Adjustment Code (CARC) 6, also known as CO 6, means that the procedure or revenue code billed does not match the patient’s age. In simple terms, the insurance payer has determined that the service billed is not appropriate for the patient’s age group based on medical coding and payer…
What is CO 4 Mean? The CO 4 denial code stands for “The procedure code is inconsistent with the modifier used, or a required modifier is missing.” In the fast-paced world of medical billing, accuracy is everything. One small coding or modifier mismatch can lead to payment delays or denials. Let’s break down what this…
In medical billing, timing is everything. Even if the claim details, coding, and documentation are perfect, submitting services outside a patient’s coverage dates can still result in denial. Two common denial codes that fall into this category are CO 26 and CO 27. These codes indicate that the billed services were provided before the insurance…
What is CO 96 Mean? The CO 96 denial code stands for “Non-Covered Services.” The CO 96 denial code means that the insurance company has denied payment because the service is not covered under the plan or contract. In simple words, it means the payer will not pay for the service because it is not included in the…