Reference
Claim Adjustment Reason Codes explain why a claim was denied. Use this guide to understand each code, the best appeal strategy, and expected success rates for behavioral health.
Procedure code inconsistent with modifier used or required modifier missing
Diagnosis inconsistent with the procedure
Claim lacks information or has submission/billing error(s)
Exact duplicate claim/service
Care may be covered by another payer per coordination of benefits
Expenses incurred after coverage terminated
Time limit for filing has expired
Not deemed medically necessary by the payer
Non-covered charge(s)
Benefit included in payment for another service
Claim not covered by this payer/contractor
Benefit maximum for this time period has been reached
Information submitted does not support this many services
Precertification/authorization absent
Service not covered under patient's current benefit plan
Procedure/modifier combination not compatible with another already adjudicated
Attachment/documentation required to adjudicate this claim
Upload your ERA file. Our AI categorizes every denial, picks the strategy, and generates appeal letters automatically.