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Claim issues / denials
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Top denials (CARC)
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CO 22
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CO 97
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CO/PR B7
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CO/PR 50
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CO 236
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PR B9
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OA 18
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Rejected as unprocessable claim (RUC)
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CO 4
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CO 16
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CO 24
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CO 109
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CO 181
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Return to provider (RTP)
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Duplicate claims (e.g., 38032 & 38037)
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12206
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153XX-154XX
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30912
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30949
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30960
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31197
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32400-32404
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326x4
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34931
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38200
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70RTP
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W7088
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Reject reason codes
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U5233
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CO B9
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34538
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76474
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Processing issues
Tips to prevent reject reason code 31997
This reason code is assigned when the TOB is equal to inpatient (11x, 18x, 21x, or 41x), the non-covered charges are greater than zero and are equal to the total charges, and occurrence span code (OSC) 79 or M1 is present on the claim. These OSC indicate a period of non-covered care that is not medically necessary for which the provider is liable.
Refer to the Part A Reason Code Lookup for a description associated with the Medicare Part A reason code(s). Enter a valid reason code into the box and click the submit button.
Reference