Aetna denial codes list

Aetna denial codes list

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At least Using an incorrect diagnosis code. Reason Code Claim/service lacks information which is needed for adjudication. We are aware of these erroneous denials on claims billed on a UB form and front-end rejections on claims billed on a CMS forms Reason Code The date of death precedes the date of service. Search box will These codes are needed on your secondary claim submission to Aetna in order to provide information on a previous payer’s payment. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Find the phone number, form, and deadline for your appeal and the Aetna external review program Eligibility Clarification Code is not used for this Transaction Code 3Ø9‐CGroup ID is notused for this Transaction Code 3Ø1‐CPerson Codeis not used for this Transaction Code 3Ø3‐CPatient Relationship Code is not used for this Transaction Code 3Ø6‐C6 Provider manual Resources, policies and procedures at your fingertips (4/24) Payers deny your claim with code COwhen the diagnosis code you submitted on the claim doesn’t align with the procedure or service performed. If all that’s known about the ,  · D– Claims are denied because procedure was not re certified. Start/01/ Patient identification compromised by identity theft. Reason Code The date of birth follows the date of service. Reason Code The authorization number is missing, invalid, or does not apply to the billed services or provider. Click on Claims, CPT/HCPCS Coding Tool, Clinical Policy Code Search. The five character AetnaLearn how to appeal a denied claim by Aetna and request an external review if needed. Health benefits and health insurance plans contain exclusions and limitations. This situation can arise for several reasons, such as: Making a typo in the diagnosis code. DMC – There is insufficient information to determine Reason Code Details: Reason Code Reason Description Claim denials are defined by RARC codes established by CMS. There are many different remittance adjustment reason codes (RARCs) established for Medicare and we Visit the secure site, available through, for more information. Provider manual Resources, policies and procedures at your fingertips (4/24) Orthotic and prosthetic supply, accessory, an/or service component of another L code Q Drug or biological, not otherwise classified, Part B drug competitive Q Skin Here is a comprehensive reason codes list: Do you have reason code with you? These codes are needed on your secondary claim submission to Aetna in order to provide information on a previous payer’s payment. Submitting a diagnosis code that isn’t supported by the patient’s Legal notices. See all legal notices. Want to know what is the exact reason? Just hold control key and press ‘F’. Identity verification required for processing this and future claims paper remittances, along with some correlating industry standard Adjustment Reason Codes values and Adjustment Group Code value. Health care providersget answers to the most Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. If the previous payer sent a HIPAA standard You can find claims adjustment reason code values and site at When a general code is found for a category, we list it in bold. Claim refiled with the auth# and got paid. If the previous payer sent a HIPAA standard ERA these codes will be Following our review, we identified a period from 8/26//3/during which providers received denials and front-end rejections when they were in fact active per the most updated file.