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Type a claim adjustment reason code, or just what the payer told you, and get the official description plus the first thing to check. 77 codes covered. It runs entirely in your browser — nothing you type leaves your machine.
77 guides. Nothing is sent anywhere — this runs entirely in your browser.
Prior authorization absent
The payer required prior authorization for this service and cannot find one attached to the claim.
Pull the authorization record and compare four things against the claim: the CPT code, the units, the date range and the rendering provider
Claim lacks information or has a submission error
Something on the claim is missing or malformed. On its own the code tells you nothing — the detail is in the remark code that comes with it.
Read the RARC remark code attached to the denial — CO-16 alone is not actionable and the remark is where the actual reason lives
Time limit for filing has expired
The claim arrived after the payer’s filing deadline. This one is usually terminal, which is why it deserves attention before it happens rather than after.
Check whether you can prove timely submission: a clearinghouse acceptance report with a date inside the window will overturn many of these
Not deemed medically necessary
The payer does not accept that the documentation supports the service. This is a clinical argument, not a clerical one.
Find the payer’s own coverage policy, the LCD or NCD for Medicare, and read what it actually requires — appeals that do not quote the policy mostly fail
Charge exceeds the fee schedule
A contractual write-off rather than a denial. It only becomes a problem when the allowed amount is wrong.
Compare the allowed amount against your contracted rate for that CPT. If they agree, post the adjustment and move on
Included in the payment for another service
The payer is bundling this code into another one on the same claim. Sometimes that is correct and sometimes it is not.
Check the NCCI edit pair and whether a modifier is permitted to break it — some pairs allow it and some do not, and billing a modifier on a pair that does not allow one is a compliance problem, not a shortcut
Exact duplicate claim or service
The payer already has this claim. Usually harmless, occasionally a sign that the original is stuck.
Find the original claim and check its status before doing anything else — most CO-18 work is wasted because the original was fine
May be covered by another payer
The payer thinks somebody else is primary. Until coordination of benefits is corrected on their file, nothing on this claim will pay.
Call the patient before you call the payer. They can usually resolve the COB record themselves in one phone call, and the payer will not update it on your say-so
Expenses incurred after coverage terminated
The patient was not covered on the date of service.
Re-run eligibility for the exact date of service and keep the transaction record
Information does not support this many services
The payer accepts the service but not the quantity or the frequency at which it was billed.
Check the payer policy for the frequency limit and the period it runs over — a rolling twelve months and a calendar year are different things and practices lose money on that distinction
Not covered by this payer or contractor
It went to the wrong place.
Re-verify eligibility and read which plan is actually active, including the plan type, not just whether coverage exists
Provider not certified or eligible on this date
A credentialing or enrollment problem rather than a claim problem: nothing this provider bills to this payer will pay until it is fixed, and it is rarely one claim.
Establish the effective date of the enrollment before touching the claims — that date tells you which claims are recoverable
Looking up one denial takes a minute. Working a whole queue of them is somebody’s week, every week. Send an aged AR report and you get back, in writing, what is recoverable and what working it would take — free, whether or not you buy anything.
Nothing you typed into the tool above is attached to this. This form sends the three fields in it and which page it came from — that is all it can send. Or write to info@softhomebpo.com and skip the form entirely. What happens to it.
Billing companies and BPOs buy seats in one yes, not one at a time — published tiers from 5 seats, a 3-seat prepaid pilot first. Leave your details and the partner desk will call, not the sales queue.
This form sends the three fields above and which page it came from, to the partner desk — not the practice sales queue. Read the published tiers or write to ops@softhomeglobal.com directly.
A denial is a group code, a reason code and usually a remark code. Read together they say who is liable, what is missing and what to do — CO-16 with M51 is a different afternoon from CO-16 with MA130. Every X12 reason and remark code, official text. More on remark codes →
Showing an example line (CO-16 M51). Paste your own or pick another. Group code, reason code and remark code together. The full reason and remark code lists, official X12 text. Runs in your browser: the tables load once as a file; what you type is not sent anywhere.
Loading the code tables…
Yes, and there is nothing to sign up for. It runs entirely in your browser — nothing you type is sent anywhere, which matters when the thing you are looking up relates to a real claim.
The official text is the X12 claim adjustment reason code set, used by every United States payer. Everything after that description is our own working guidance, and it is labelled as such.
Link to it freely. If a code your team keeps hitting is missing, say so and it will be added — the guides are written from the codes people actually get stuck on rather than from a list.
Because somebody looking up a denial code at four in the afternoon is exactly the person who later needs somebody to work the queue. Being useful first is cheaper than advertising and it lasts longer.
Sources checked 2026-09-10.
The tool answers one question. A seat answers the queue.
Next step
These guides tell you what to do. A seat is somebody doing it, every working day, during your business hours.
Or write to ops@softhomeglobal.com
