Code | System | Display |
ELIG-001 | http://hcxprotocol.io/codes/denial-code | Patient is not a covered member |
ELIG-005 | http://hcxprotocol.io/codes/denial-code | Services performed after the last date of coverage |
ELIG-006 | http://hcxprotocol.io/codes/denial-code | Services performed prior to the effective date of coverage |
ELIG-007 | http://hcxprotocol.io/codes/denial-code | Services performed by a non-network provider |
AUTH-001 | http://hcxprotocol.io/codes/denial-code | Prior approval is required and was not obtained |
AUTH-003 | http://hcxprotocol.io/codes/denial-code | PriorAuthorizationNumber is invalid |
AUTH-004 | http://hcxprotocol.io/codes/denial-code | Service(s) is (are) performed outside authorization validity date |
AUTH-005 | http://hcxprotocol.io/codes/denial-code | Claim information is inconsistent with pre-certified/authorized services |
AUTH-006 | http://hcxprotocol.io/codes/denial-code | Alert drug - drug interaction or drug is contra-indicated |
AUTH-007 | http://hcxprotocol.io/codes/denial-code | Drug duplicate therapy |
AUTH-008 | http://hcxprotocol.io/codes/denial-code | Inappropriate drug dose |
AUTH-009 | http://hcxprotocol.io/codes/denial-code | Prescription out of date |
AUTH-010 | http://hcxprotocol.io/codes/denial-code | Authorization request overlaps or is within the period of another paid claim or approved authorization |
AUTH-011 | http://hcxprotocol.io/codes/denial-code | Waiting period on pre-existing / specific conditions |
AUTH-012 | http://hcxprotocol.io/codes/denial-code | Request for information |
BENX-002 | http://hcxprotocol.io/codes/denial-code | Benefit maximum for this time period or occurrence has been reached |
BENX-005 | http://hcxprotocol.io/codes/denial-code | Annual limit/sublimit amount exceeded |
CLAI-007 | http://hcxprotocol.io/codes/denial-code | Claim is a work-related injury/illness and thus the liability of the employer |
CLAI-008 | http://hcxprotocol.io/codes/denial-code | Claim overlaps inpatient stay. Resubmit only those services rendered outside the inpatient stay |
CLAI-009 | http://hcxprotocol.io/codes/denial-code | Date of birth follows the date of service |
CLAI-010 | http://hcxprotocol.io/codes/denial-code | Date of death precedes the date of service |
CLAI-011 | http://hcxprotocol.io/codes/denial-code | Inpatient admission spans multiple rate periods. Resubmit separate claims |
CLAI-012 | http://hcxprotocol.io/codes/denial-code | Submission not compliant with contractual agreement between provider & payer |
CLAI-014 | http://hcxprotocol.io/codes/denial-code | Claim not compliant with Resubmission type (used only for resubmissions) |
CLAI-017 | http://hcxprotocol.io/codes/denial-code | Services not available on direct billing |
CLAI-018 | http://hcxprotocol.io/codes/denial-code | Claims Recalled By Provider |
CODE-010 | http://hcxprotocol.io/codes/denial-code | Activity/diagnosis inconsistent with clinician specialty |
CODE-012 | http://hcxprotocol.io/codes/denial-code | Encounter type inconsistent with service(s) / diagnosis |
CODE-013 | http://hcxprotocol.io/codes/denial-code | Invalid principal diagnosis |
CODE-014 | http://hcxprotocol.io/codes/denial-code | Activity/diagnosis is inconsistent with the patient's age/gender |
CODE-015 | http://hcxprotocol.io/codes/denial-code | Activity/diagnosis is inconsistent with the provider type |
DUPL-001 | http://hcxprotocol.io/codes/denial-code | Claim is a duplicate based on service codes and dates |
DUPL-002 | http://hcxprotocol.io/codes/denial-code | Payment already made for same/similar service within set time frame |
MNEC-003 | http://hcxprotocol.io/codes/denial-code | Service is not clinically indicated based on good clinical practice |
MNEC-004 | http://hcxprotocol.io/codes/denial-code | Service is not clinically indicated based on good clinical practice, without additional supporting diagnoses/activities |
MNEC-005 | http://hcxprotocol.io/codes/denial-code | Service/supply may be appropriate, but too frequent |
MNEC-006 | http://hcxprotocol.io/codes/denial-code | Alternative service should have been utilized |
NCOV-001 | http://hcxprotocol.io/codes/denial-code | Diagnosis(es) is (are) not covered |
NCOV-002 | http://hcxprotocol.io/codes/denial-code | Pre-existing conditions are not covered |
NCOV-003 | http://hcxprotocol.io/codes/denial-code | Service(s) is (are) not covered |
NCOV-025 | http://hcxprotocol.io/codes/denial-code | Service(s) is (are) not performed (used after audit) |
PRCE-001 | http://hcxprotocol.io/codes/denial-code | Calculation discrepancy |
PRCE-002 | http://hcxprotocol.io/codes/denial-code | Payment is included in the allowance for another service |
PRCE-003 | http://hcxprotocol.io/codes/denial-code | Recovery of Payment |
PRCE-006 | http://hcxprotocol.io/codes/denial-code | Consultation within free follow up period |
PRCE-007 | http://hcxprotocol.io/codes/denial-code | Service has no contract price |
PRCE-008 | http://hcxprotocol.io/codes/denial-code | Multiple procedure payment rules incorrectly applied |
PRCE-009 | http://hcxprotocol.io/codes/denial-code | Charges inconsistent with clinician specialty |
PRCE-010 | http://hcxprotocol.io/codes/denial-code | Use bundled code |
PRCE-011 | http://hcxprotocol.io/codes/denial-code | Discount discrepancy |
TIME-001 | http://hcxprotocol.io/codes/denial-code | Time limit for submission has expired |
TIME-002 | http://hcxprotocol.io/codes/denial-code | Requested additional information was not received or was not received within time limit |
TIME-003 | http://hcxprotocol.io/codes/denial-code | Appeal procedures not followed or time limits not met |
COPY-001 | http://hcxprotocol.io/codes/denial-code | Deductible/co-pay not collected from member |
SURC-001 | http://hcxprotocol.io/codes/denial-code | Severe drug - drug interaction |
SURC-002 | http://hcxprotocol.io/codes/denial-code | Severe drug - age contraindication |
SURC-003 | http://hcxprotocol.io/codes/denial-code | Severe drug - gender contraindication |
SURC-004 | http://hcxprotocol.io/codes/denial-code | Severe drug - diaganosis contraindication |
SURC-005 | http://hcxprotocol.io/codes/denial-code | Severe procedure\service - diagnosis contraindication |
SURC-006 | http://hcxprotocol.io/codes/denial-code | Severe procedure\service - drug contraindication |
SURC-007 | http://hcxprotocol.io/codes/denial-code | Severe procedure\service - procedure contraindication |
SURC-008 | http://hcxprotocol.io/codes/denial-code | Serious safety issue with drug dose |
WRNG-001 | http://hcxprotocol.io/codes/denial-code | Wrong submission, receiver is not responsible for the payer within this transaction submission. |
CLAI-019 | http://hcxprotocol.io/codes/denial-code | Wrong IR-DRG code |
CLAI-020 | http://hcxprotocol.io/codes/denial-code | Missing IR-DRG code |