Naturopathic claim denial reason codes are alphanumeric codes. They indicate why an insurance provider denied a reimbursement claim. Denial codes explain all the reasons why the claim was denied.
Understanding these codes can help the providers rectify a claim, resubmit, and get faster reimbursement. This comprehensive guide explains the common reasons and codes for Naturopathic claims denials.
What are Denial Codes
Insurance providers use denial codes to explain reasons for claim rejection. These codes provide a basic explanation of the rejections, helping medical billing companies understand the root causes and fix the issues.
Denial codes also play a key role in improving transparency around claim rejections. Moreover ,allowing the billing team to take the necessary actions and identify the reasons before resubmitting the claims.
Here are the Denial Reason Codes for Naturopathic Claims
- CO-16: Claim/service lacks information or has incomplete documentation
- CO-18: Duplicate claim/service
- CO-19: Duplicate procedure/service
- CO-22: Procedure code not covered by payer/benefit plan
- CO-29: Timely filing limit exceeded
- CO-50: Non-covered services
- CO-97: Pre-certification/authorization not received
- CO-109: Claim not covered under this payer/plan
- CO-150: Claim/service denied for medical necessity
Understanding Authorization Denials in Naturopathic Billing
In naturopathic billing, authorization denial occurs when an insurance provider denies coverage for a specific medical procedure. It is because the payers consider it a non-necessary treatment for the patient.
This authorization ensures that patients receive cost-effective treatment for diseases that negatively impact their daily functioning.
Below are the reasons for prior authorization denials
- Unclear reasons for the suggested treatment
- Inaccurate codes
- Typo errors
- No proof of clinical data in the documents
Denial Reason Codes Explanation
CO-16: Claim/service lacks information
This denial occurs when a claim is submitted with missing or insufficient details. The payer cannot process the claim without complete data. These institutions check patient information, diagnosis, procedure codes, or supporting records.
Therefore, healthcare providers must supply the missing information to avoid rejection and maximize practice revenue.
CO-18: Duplicate claim/service
This code is used when the payer identifies that the same service or claim has already been submitted and processed. Duplicate claims may occur due to billing errors or resubmissions. Verification is required to ensure proper payment and prevent overbilling.
CO-19: Duplicate procedure/service
Denial under this code happens when the same procedure is billed multiple times for the same patient on the same date of service. The payer considers it a duplicate. Providers must review records and correct any duplicate submissions.
CO-22: Procedure code not covered by payer/benefit plan
This denial occurs when a billed procedure is not covered by the patient’s insurance plan. The service is considered excluded. Providers should verify coverage and, if possible, consider alternative codes or obtain prior authorization.
CO-29: Timely filing limit exceeded
This denial occurs when a claim is submitted after the insurer’s allowed filing period. Most payers have strict time limits for submission. Providers should track submission deadlines and submit claims promptly to prevent denial due to late filing.
CO-50: Non-covered services
This code is used when the service provided is excluded from the patient’s insurance benefits. The payer does not cover the charge. Providers should check plan coverage and inform patients about out-of-pocket costs before treatment.
CO-97: Pre-certification/authorization not received
Claims are denied under this code if prior authorization was not obtained before the service was given. Many procedures require prior approval. Providers must ensure all necessary authorizations are completed to avoid denial.
CO-109: Claim not covered under this payer/plan
This denial occurs when the patient’s current insurance plan does not cover the submitted claim. It may be due to plan restrictions, or eligibility issues. Providers should verify coverage and advise patients accordingly.
CO-150: Claim/service denied for medical necessity
Claims are denied under this code if the payer determines the service was not medically necessary based on clinical guidelines. Documentation must support the medical need. Providers may appeal with sufficient evidence to justify the treatment.
How to Prevent Naturopathic Claim Denials
Claim denials only increase workload and cause revenue loss. Usually, healthcare organizations rely on professional billing agencies to optimize their revenue cycle.
If you are a solo practitioner or a small clinic with a limited budget, adopting best practices is the only way to avoid denials and maximize the practice revenue.
Review the Denial Notice
Reviewing the previous denials is a great first step to prevent claim rejections. The insurance payers mention every reason behind the claim rejection in this notice.
Here, the Naturopathic Doctor must double-check every reason and verify the notice with the insurance policy to identify the root cause.
Create a checklist
Healthcare experts must prepare a denial prevention checklist. They should mark off when preparing and submitting the claim. Without a proper checklist, providers might face repeated claim rejections and lose potential revenue.
Carefully Address the Denied Claims
Filing an appeal for the rejected claim is very complex and time-consuming. Therefore, it must be addressed properly; every mistake should be removed before submission. Moreover, experts should consider the time limit for re-filing to avoid late submission.
Track the Progress
Maintaining a record of the denied claims is an excellent strategy. It helps them monitor progress, reduce excessive workload, improve operational productivity, and maximize practice revenue. Monitoring every denial also increases providers’ knowledge of how to handle rejected claims.
Steps After Receiving A Denied Claim
As discussed above, a provider must address the denial promptly upon receipt. Below are best practices for addressing a rejected claim and recovering lost revenue.
- Cross-check the denial: Upon receiving a rejected claim, the provider should review the details to determine the main reason for the rejection.
- Gather supporting documents: It is important to collect important documents and maintain them in a file.. Missing any document will lead to claim rejection.
- Coordinate with Payer: timely resubmission is crucial to get reimbursements. ignoring a denied claim can quickly turn into lost revenue. Therefore, experts should coordinate with insurance companies and resubmit the claim.
Final Thoughts
Common denial reason codes for Naturopathic claims include co-16, co-19, co-20, and more. Moreover, understanding these denial codes helps providers identify problems and resolve them.
Some organizations prefer hiring expert billing agencies to handle these complex tasks. Solo practitioners and small clinics lack the budget and resources to bring in a dedicated team.
This blog offers denial-prevention strategies to help the Naturopathic doctor avoid the risks of repeated claim rejections and maintain a healthy revenue cycle.
Frequently Asked Questions
What are common denial reason codes?
- Denial Code CO-11: Error in Diagnosis Code
- Denial Code CO-15: Missing or Invalid Authorization Number
- Denial Code CO-16: Missing Information
- Denial Code CO-18: Duplicate Claim or Service
- Denial Code CO-22: Benefit Out of Network
- Denial Code CO-29: Time Limit Expiry
What are the most common denial reason codes for naturopathic insurance claims?
- CO‑4
- CO‑11
- CO‑16
- CO‑18
- CO‑22
- CO‑29
- CO‑45
- CO‑97
What does the denial code CO‑11 mean on a naturopathic claim?
CO‑11 indicates the diagnosis code didn’t match the procedure billed or the service wasn’t supported by the payer’s coverage guidelines.
Why do claims get denied with CO‑4 for naturopathic services?
CO‑4 means a required CPT/HCPCS modifier is missing or inconsistent, usually due to an incorrect or missing modifier on the billed procedure.
What common administrative issues cause claims denials for naturopathic providers?
Missing patient information, incorrect data, late filing, or lack of prior authorization often trigger denials and associated payer rejection codes.