Wiki Denial code m16

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sawhitt

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Can anyone tell me what this code is? I have researched and can only get the message to read newsletters, bulletins, website for explanations.

Help!

Susan Whitt
 
That's what the denial code means....your payer has made a recent determination or change with regards to that particular service, claim or adjudication process, and has made notification of that on their website. Chances are there's been a recent bulletin or other communication that will explain the denial or delay reason.
 
The M16 should've been just a remark code. There should be other codes on the remit, especially if it was Medicare, like a CO or PR or OA code as well that should give the actual claim denial reason.
 
pr 96

can anyone help me with deniel code pr 96, does anyone one know how to go around this code and if not how do i explan this code to the doctor as to why it was denied

Betty
 
PR is patient responsibility and 96 is non-covered charges. You cannot get around this code because the insurance company does not cover the charge you billed for. The patient would need to check their insurance coverage for covered/non-covered services. Here's a link to Washington Publishing Company. They list the claim adjustment remark codes and the remittance advice remark codes. http://www.wpc-edi.com/reference/
 
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