Get the free Ineligible Codes List

A comprehensive list of ineligible codes and their descriptions used by HMAA to identify claims that cannot be processed for various reasons.

How to fill out ineligible codes list

How to fill out Ineligible Codes List

1. Obtain the Ineligible Codes List template from the relevant authority.
2. Review the instructions provided with the template for guidance.
3. Identify the categories of ineligible codes relevant to your context (e.g., financial, compliance, etc.).
4. For each code, ensure you have the correct format, typically including a code number and description.
5. Fill out the list by entering each ineligible code, along with a brief explanation if required.
6. Double-check for any errors and ensure all required information is included.
7. Save the completed document in the designated file format.
8. Submit the list to the relevant department or authority by the deadline.

Who needs Ineligible Codes List?

1. Organizations that require a catalog of codes that cannot be used for reporting or compliance purposes.
2. Departments responsible for maintaining regulatory standards and compliance.
3. Auditors and compliance officers who need to verify adherence to established criteria.
4. Financial institutions and businesses that need to prevent errors in transactions or reporting.

People Also Ask about

What are the denial codes?

Medical Billing Denial Codes Co-4 — Omission Of A Required Modifier. Co-11 – An Error In Coding. Co-15 – Missing Or Invalid Authorization Number. Co-16 – Incomplete Information. CO-18 – Double Billing. CO-22 – Coordination Of Benefits. CO-27 – Expenses Incurred After The Patient's Insurance Expired.

What is CO 96 denial?

CO 96 denial means that: Claim Rejected Due to Non-Covered Charge. This specifically highlights that the patient was not covered for the services received, leading to claim denial.

What is a denial code?

Denial codes give specific explanations for claim rejections, allowing billers and healthcare providers to know what caused the denial, thus enabling them to take necessary actions that can lead to issue resolution. Claim rejection has become more transparent and evident thanks to denial codes that benefit patients.

What are the three types of denials?

Payer Denials: Eligibility denial. Authorization Denial. Coverage Denials.

What is a 256 denial code?

The CO‑256 Denial Code indicates that a service is not covered by the patient's insurance, often due to policy exclusions or lack of medical necessity. Common causes include the absence of prior authorization and experimental treatments.

What is a code 44 rejection?

Denial code 44 is related to a prompt-pay discount. This means that the claim has been denied because the healthcare provider has applied a discount for prompt payment, but the claim does not meet the criteria for this discount.

What is a 187 denial code?

Exceeded account limits: If the consumer spending account has a limit or cap on the amount that can be used for payment, exceeding this limit can result in code 187. This can occur if the healthcare provider bills for services that exceed the available balance in the account.

What is the 4 denial code?

What is Denial Code 4. Denial code 4 is used when the procedure code is inconsistent with the modifier that was used. This means that the modifier attached to the procedure code does not match the requirements or guidelines set by the payer.

For pdfFiller’s FAQs

What is Ineligible Codes List?

The Ineligible Codes List is a compilation of codes that are deemed ineligible for particular transactions or claims, usually in health insurance or other regulatory frameworks.

Who is required to file Ineligible Codes List?

Entities such as healthcare providers, insurers, or organizations that submit claims or transactions affected by coding standards are required to file the Ineligible Codes List.

How to fill out Ineligible Codes List?

To fill out the Ineligible Codes List, one must accurately list the ineligible codes along with relevant details such as the code description and the reason for ineligibility, usually following the prescribed format set by the governing authority.

What is the purpose of Ineligible Codes List?

The purpose of the Ineligible Codes List is to provide clarity and transparency regarding which codes cannot be used in claims or transactions, helping to reduce errors and ensure compliance with regulatory standards.

What information must be reported on Ineligible Codes List?

The information that must be reported on the Ineligible Codes List includes the specific ineligible codes, descriptions of the codes, the reason for their ineligibility, and any applicable dates or additional notes as required by the filing authority.