Pr 49 denial code

Avoiding denial reason code PR 49 FAQ Q: We received a denial with claim adjustment reason code (CARC) PR 49. What steps can we take to avoid this denial? Routine examinations and related services are not covered. A: This denial is received when the claim is for a routine/preventive exam or a diagnostic/screening procedure, done in …

Pr 49 denial code. Additional Non Recoverable Codes. PR - Patient Responsibility Adjustments. PR 1 - Deductible - the amount you pay out of pocket. PR 2 - Coinsurance once the annual deductible is reached, the insurance company will begin to pay a portion of all covered costs. PR 3 - Co-payment some insurance plans do not have deductibles or coinsurance at all ...

Common Reasons for the Denial CO 119. Services provided exceed the policy's coverage limits or frequency. The patient has already utilized the maximum number of allowed visits or services for a specific period. Duplicate submissions of the same service or claim. Incorrect coding of the services provided, leading to the insurance company ...

ANSI Codes. American National Standard Institute (ANSI) codes are used to explain the adjudication of a claim and are the CMS approved ANSI messages. Group codes must be entered with all reason code (s) to establish financial liability for the amount of the adjustment or to identify a post-initial-adjudication adjustment.code 5. Note: You cannot use frequency code 5 for Medicare Advantage claims. • To change the type of bill from outpatient to inpatient, or from inpatient to outpatient on a professional or facility claim. • To make changes to "bridged admission" facility claims. Follow appeal guidelines in the . Blue Book.45: Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. CO-45 : As the description states, this denial o...To determine the appropriate LAF code to apply for returned checks, see SM 03020.001. NOTE: For undeliverable mail such as forms and notices, refer to GN 02605.055 Title II Undeliverable Mail - Change of Address (COA). B. Procedure - Efforts to locate 1. Required Efforts ...OK, so CO-170 means: This payment is adjusted when performed/billed by this type of provider. The CO represents "contract issue" meaning that there may be something in your contract, with that specific insurance company, that is not allowing the NPPs to bill for these services. Contracts are updated by some insurance companies quarterly and/or ...PR - Patient Responsibility - We could bill the patient for this denial however please make sure that any other rejection reason not specified in the EOB. Same denial code can be adjustment as well as patient responsibility. For example PR 45, We could bill patient but for CO 45, its a adjustment and we can't bill the patient.Denial code PR 49, CO 236 how to prevent the denial Avoiding denial reason code PR 49 FAQ Q: We received a denial with claim adjustment reason code (CARC) PR 49.

49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. ... FIGURE 2.G-1 DENIAL CODES (CONTINUED) ADJUST/DENIAL REASON CODE DESCRIPTION HIPAA Adjustment Reason Codes Release 11/05/2007. C-4, November 7, 2008.Code. Description. Reason Code: 109. Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor. Remark Code: N104. This claim/service is not payable under our claim’s Jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS ...deny: cpt or dx code is not valid for age of patient : 07; 7 : deny: the procedure code is inconsistent with the patient's ... adjustment: third party liability, subrogation recovery received . 24; 24 . ... 49. 49 . deny: these are noncovered services because this is a …BCBS insurance denial codes differ state to state and we could not refer one state denial code to other denial. Here we have list some of th... Venipuncture CPT codes - 36415, 36416, G0471Denial Occurrences : This denial has 2 categories: Non-covered charges as per patient plan Non-covered charges as per provider contract Non-...We received a denial with claim adjustment reason code (CARC) PR 49. What steps can we take to avoid this denial? Routine examinations and related services are not covered. A: There are a few scenarios that exist for this denial reason code, as outlined below.PR Meaning: Patient Responsibility (patient is financially liable). A provider is prohibited from billing a Medicare beneficiary for any adjustment amount identified with a CO group code, but may bill a beneficiary for an adjustment amount identified with a PR group code. For example, reporting of reason code 50 with group code PR (patient ...BCBS insurance denial codes differ state to state and we could not refer one state denial code to other denial. Here we have list some of th... Venipuncture CPT codes - 36415, 36416, G0471

If revenue code 0655 (respite) or 0656 (general inpatient care) is present on your claim, a value code 'G8' is required in the value code field (FL 39-41 or 'Value Code' field on FISS Page 01). If revenue code 0651 (routine home care) or 0652 (continuous home care) is present on your claim, a value code '61' is required in the value code field ...Denial code 94: The claim is a duplicate of a previously submitted paid claim ... 49). o The UB modifier, which has expanded permission for use during the State.When the patient's name is misspelled, date of birth is entered incorrectly, or the billing code claim is incorrect, the claim will likely be denied. 3. Billing the Wrong Company. In the era of Obamacare, many consumers change health insurers every year, as rates change and new providers enter or leave the marketplace.Code. Description. Reason Code: 204. This service/equipment/drug is not covered under the patient's current benefit plan. Remark Code: N130. Consult plan benefit documents/guidelines for information about restrictions for this service.... 49. 11. The Tamil Nadu Police Service Recruitment, pay etc ... Code --- ............................................................... 749. 576. Report to ...

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One such scenario, of impact to providers, involves . Prior to the October claim adjustment requests implementation, Highmark rejected the Frequency Type 7 and 8 claims with standardized HIPAA 835 code OA125 ("Submission/billing error") and proprietary code E0775 (“The adjustment request received from the facility has been …Denial Codes In Medical Billing - Remit Codes List With - Unbate. 99382 coded when patient's age 1 through 4 years. 99383 age 5 through 11 years. 99384 age 12 through 17 years. 99385 age 18 to 39 years. 99386 age 40 to 64 years. 99387 age 65 years and older.Medicare established coverage provisions for Cardiac Rehabilitation (CR) and Pulmonary Rehabilitation (PR) programs. The regulation at 42 CFR 410.49 includes coverage provisions for CR and PR items and services, physician standards and limitations to the sessions that may be covered. Access the below related information from this page.Oct 16, 2015 · If a modifier is applicable to the claim, apply the appropriate modifier and resubmit the claim. Be sure to submit only the corrected line. Resubmitting an entire claim will cause a duplicate claim denial. Avoiding denial reason code PR B9 FAQ Q: We received a denial with claim adjustment reason code (CARC) PR B9. Reason/Remark Code Lookup. Use the Code Lookup to find the narrative for ANSI Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). You can also search for Part A Reason Codes. Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed. Remittance Advice Remark Codes provide additional ...

This value or value 58 is required on the initial bill for oxygen therapy and on the fourth month's bill. The hospital reports right justified in the cents area. Round to nearest whole percentage, i.e., report 56.5 as 57 to the right of the cents delimiter. Codes 58 & 59 are not money amounts.hold code process) 3; Copayment amount. 3 Copayment amount. PR; Non - Covered PV; 4 The procedure code is inconsistent w/modifier used or req. modifier is misiing. MA does not allow svc. 4; The procedure code is inconsistent with the modifier used or required modifier is misiing. OA Non - Covered; XM 4; The procedure code is inconsistent w/modifierNavigating the labyrinthine world of medical billing can often be likened to solving an intricate puzzle. At the heart of this puzzle are denial codes - the catalysts that can either streamline revenue cycles or throw them into disarray. With a comprehensive understanding of denial codes and cutting-edge solutions like Adonis Intelligence, healthcare providers can wield an impeccable blend ...Common Reasons for Denial. Prior authorization 14-byte Unique Tracking Number (UTN) was not appended to claim; Special modifier to bypass the prior authorization process was not appended to claim line. This HCPCS code requires prior authorization; Next Steps. Correct claim and rebill with the 14-byte UTN provided within the affirmative decision ...When it comes to denial management in medical billing, the U.S. experiences large market sizes each year.. In fact, according to the U.S. Healthcare Denial Management Markets, in 2021 denial management reached a value of $3.54 billion.And experts say that this could rise to almost $6 billion dollars by 2027! If you're reading this and you're in the medical billing field, I'm sure I don ...Reason/Remark Code Lookup. Use the Code Lookup to find the narrative for ANSI Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). You can also search for Part A Reason Codes. Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed. Remittance Advice Remark Codes provide additional ... The American Medical Association's most recent study found that major payers return to up to 29% of claims with $0 payment. This happens most commonly because the patient is responsible for the balance. It also happens 7% of the time because of claim edits and 5% of the time because of other denials. The good news is that many denied claims ...15-Mar-2022 ... Same denial code can be adjustment as well as patient responsibility. For example PR 45, We could bill patient but for CO 45, its a adjustment ...Navigating the labyrinthine world of medical billing can often be likened to solving an intricate puzzle. At the heart of this puzzle are denial codes - the catalysts that can either streamline revenue cycles or throw them into disarray. With a comprehensive understanding of denial codes and cutting-edge solutions like Adonis Intelligence, healthcare providers can wield an impeccable blend ...... PR 47. These diagnosis are not covered, missing, or are invalid. PR 49. These are non-covered services because this is a routine exam or screening procedure ...By. Admin. -. November 14, 2021. 0. 5591. Payers will deny the claims with CO 26 Denial Code - Expenses incurred prior to coverage, whenever the providers perform health care services to patient prior to the insurance coverage starts.

24-Mar-2022 ... EDIT 0083 - REV CODE 099, 36X, 37X, 49X OR 71X REQ VALID SURGICAL PROC ... reason code 2166; an adjustment reason code. 2166 is present but the ...

Best answers. 0. Oct 5, 2012. #2. You can find denial codes at Wasington Publishing company. I found this on their site unde claim adjustment reason codes: B7 - This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 ...Reason Codes: Provide information about claims decisions Explain why a claim was paid differently than it was billed CO, PR Remark Codes: Numerical codes that further explain the denial Indicate if/why appeal rights apply B, M, MOA, and NDenial Reason, Reason/Remark Code(s) PR-204: This service/equipment/drug is not covered under the patient’s current benefit plan. PR-49: These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. CPT code: 36415. Resolution/Resources Medicare denial codes, reason, remark and adjustment codes.Medicare, UHC, BCBS, Medicaid denial codes and insurance appeal. ... Use code 96. 49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. ... MCR - 835 Denial Code List PR - Patient Responsibility - We could bill ...If you are permitted to bill paper claims, this worksheet can be completed and sent with the UB-04 claim form. A copy of the primary remittance is still required with the UB-04 if sending in this completed worksheet. It is important to code the claim adjustment segment (CAS) of claims accurately, so Medicare makes the correct MSP payments.For this denials we need to look into following 3 segments: Procedure code, Provider and Place of service to resolve the denials: Procedure Code: 1) First check EOB/ERA to see which procedure code require authorization or reach out claims department and find out which procedure code require authorization. 2) Check in …Code. Description. Reason Code: 35. Lifetime benefit maximum has been reached. Remark Codes: N370. Billing exceeds the rental months covered/approved by the payer.hold code process) 3; Copayment amount. 3 Copayment amount. PR; Non - Covered PV; 4 The procedure code is inconsistent w/modifier used or req. modifier is misiing. MA does not allow svc. 4; The procedure code is inconsistent with the modifier used or required modifier is misiing. OA Non - Covered; XM 4; The procedure code is inconsistent w/modifier

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What is the denial code for PR patient responsibility? PR - Patient Responsibility denial code list MCR - 835 Denial Code List PR - Patient Responsibility - We could bill the patient for this denial however please make sure that any other rejection reason not specified in the EOB. Same denial code can be adjustment as well as patient ...For denial codes unrelated to MR please contact the customer contact center for additional information. Code. 39508. Benefits Exhausted. 39513. Partial Benefits Exhausted. 50125. Certification is missing altogether from additional documentation sent by provider. 50174.Last Update: 04/29/2022 HIPAA CARC Code Health Care Claim Adjustment Reason Code Description Facets EXCD Explanation Code Description 1 Deductible Amount. None 1 Start: 01/01/1995 006 Reduced Deductible 1 007 Increased Deductible. 1 460 Medicare deductible applied. 1 500 Medicare deductible. 1 D05 Increased Dental Deductible. 1 D06 Decrease Dental Deductible. 2 Co-insurance Amount.The codes can help the Medicare program determine who should receive benefits and when. The Medicare denial code system is designed to help the Medicare program as much as possible. When a person has a code, the Medicare program can determine whether the person meets the eligibility requirements for Medicare. The codes …If the letter was sent has crossed 30 days then bill the claim to the patient. If the claim is denied for COB update then check the patient payment history if the payment on nearby DOS is received from any other insurance as a primary then check the eligibility of that insurance and bill the claim to that insurance. 5.Get ratings and reviews for the top 11 foundation companies in Denver, CO. Helping you find the best foundation companies for the job. Expert Advice On Improving Your Home All Projects Featured Content Media Find a Pro About Please enter a ...2) Remittance Advice (RA) Remark Codes are 2 to 5 characters and begin with N, M, or MA. 4) Some deny EX Codes have an equivalent Adjustment Reason Code, but do not have a RA Remark Code. 3) Each Adjustment Reason Code begins the string of Adjustment Reason Codes / RA Remark Codes that translate to one or more PHC EX Code(s). If aAug 17, 2023 · But the PR Denial Code is exceptionally important for medical billing and the full form for PR stands for “Patient Responsibility”. PR 96 Denial code means non-covered charges. When the billing is done under the PR genre, the patient can be charged for the extended medical service. Most often this kind of billing is done for those items ... When it comes to denial management in medical billing, the U.S. experiences large market sizes each year.. In fact, according to the U.S. Healthcare Denial Management Markets, in 2021 denial management reached a value of $3.54 billion.And experts say that this could rise to almost $6 billion dollars by 2027! If you're reading this and you're in the medical billing field, I'm sure I don ...We would like to show you a description here but the site won't allow us.CODE HPI ROS PFSH EXAM # DX DATA RISK 99211 1 0 0 0 Min Min Min 99212 1 0 0 1 Min Min Min 99213 1 1 0 6 Lim Lim(1) Low 99214 4 2 1 12 in 2 Mult Mod (2) Mod (Rx) 99215 4 10 2 18 in 9 Ext Ext High . Improper Use of -25 Modifier •-25 modifier not used when needed •-25 modifier overuse ... ….

September 13, 2023 by NSingh (MBA, RCM Expert) POS 99 ( Place of Service 99) Among those 99 two-digit referral codes here are the low-cut to the matchless 99th POS code. Like all other codes, the Place of Service 99 code forms an integral functional part whose noteworthiness is of great value in governing the acceptability of direct billing of.timely response was received, contractors must make a §1862(a)(1) of the Act denial (except for ambulance claims where the denial may be based on §1861(s)(7) or §1862(a)(1)(A) of the Act depending upon the reason for the requested information) and indicate in the provider denial notice, using remittance advice code N102, that the denial... 49. Procedure codes that require prior authorization for Michigan and non ... PR - (See. CPT/HCPCS Manual). BCNA|MAPPO|HMO|PPO* Northwood. E0956. WHEELCHAIR ...Notes: Use code 96. 49: ... Denial reversed per Medical Review. Start: 01/01/1995 | Stop: 10/16/2003: 65: ... Notes: Use Group Code PR and code 2. 128: Newborn's services are covered in the mother's Allowance. Start: 02/28/1997: 129: Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of ...Codes and Adjustment Group Code Categorization ... PR 42 - Use adjustment reason code 45, effective 06/01/07. Deductible ... Partial Payment/Denial - Payment was either reduced or denied in order to adhere to policy provisions/restrictions. PR should be sent if the adjustmentReport proper ICD-10-CM diagnosis codes to support the medical necessity for the use of an ECG. ICD-10-CM codes and/or ranges are provided below to help with your decision process. Definitions. Codes 70010-79999, 93000-93010, and 0178T-0180T are used for reporting radiology procedures. Modifiers:-26 Professional ComponentPR - Patient Responsibility denial code list, PR 1 Deductible Amount PR 2 Coinsurance Amount PR 3 Co-payment Amount PR 204 This service/equipment/drug is not covered under the patient’s current benefit plan PR B1 Non-covered visits. PR B9 Services not covered because the patient is enrolled in a Hospice. We could bill the patient for this denial however please make sure that any other ...A: This denial reason code is received when a procedure code is billed with an incompatible diagnosis for payment purposes, and the ICD-10 code (s) submitted is/are not covered under an LCD or NCD. • Medicare contractors develop an LCD when there is no NCD or when there is a need to further define an NCD. • LCDs specify the clinical ...BCBS insurance denial codes differ state to state and we could not refer one state denial code to other denial. Here we have list some of th... Venipuncture CPT codes - 36415, 36416, G0471 Pr 49 denial code, For denial codes unrelated to MR please contact the customer contact center for additional information. Code. 39508. Benefits Exhausted. 39513. Partial Benefits Exhausted. 50125. Certification is missing altogether from additional documentation sent by provider. 50174., Impact of the 2023 Medicare cuts on Oncology The 2023 Medicare cuts are estimated to reduce reimbursements for oncology services by 1%. These cuts could lead to reduced access to care, delays in ..., PR 85 Interest amount. This change effective 1/1/2008: Patient Interest Adjustment (Use Only Group code PR) PR 126 Deductible -- Major Medical PR 127 Coinsurance -- Major Medical PR 140 Patient/Insured health identification number and name do not match. PR 149 Lifetime benefit maximum has been reached for this service/benefit category., Concurrent Review/Clinical Information 1-855-218-0587 Admissions/Census Reports/Facesheets 1-855-218-0585 Care Management 1-855-218-0586 Behavioral Health Prior, Payment included in another service - CO 97, M15, M144 AND N70, We received a denial with claim adjustment reason code (CARC) PR 49. What steps can we take to avoid this denial? Routine examinations and related services are not covered., 2) Remittance Advice (RA) Remark Codes are 2 to 5 characters and begin with N, M, or MA. 4) Some deny EX Codes have an equivalent Adjustment Reason Code, but do not have a RA Remark Code. 3) Each Adjustment Reason Code begins the string of Adjustment Reason Codes / RA Remark Codes that translate to one or more PHC EX Code(s). If a, Section 49 in The Indian Penal Code. 49. “Year”, “Month”.—Wherever the word “year” or the word “month” is used, it is to be understood that the year or the month is to be reckoned …, We have added a tool to prepare notes in the below highlighted scenarios (in bold). You will find this tool at the bottom of each scenari..., What is denial code OA 23? OA-23: Indicates the impact of prior payers (s) adjudication, including payments and/or adjustments. No action required since the amount listed as OA-23 is the allowed amount by the primary payer. OA-109: Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor., Last Modified: 3/23/2023 Location: FL, PR, USVI Business: Part B. Using web tools to handle top denied claims in your practice. ... The top denial codes represent all Part B Medicare providers in Florida, USVI and Puerto Rico. If you would like to see the top denial codes for your medical practice, ..., Medicare denial codes, reason, remark and adjustment codes.Medicare, UHC, BCBS, Medicaid denial codes and insurance appeal. ... • OA - Other Adjustments. This group code shall be used when no other group code applies to the adjustment. • PR - Patient Responsibility. ... Note: Inactive for 004010, since 6/00. Use code 96. 49 These are non ..., Furthermore, what exactly is PR 1 medical billing? ... Medicare rejection codes – complete list; OA: Other modifications When the OA Group Reason code cannot be applied, the other Group Reason code is used instead. OA 18 Incorrect or duplicate claim/service. OA 19 Claim refused because there is a work-related injury or sickness, …, Blue Cross Blue Shield of Michigan providers, find manuals and resources, including the Blue Cross Complete Provider Manual and our Dental Provider Manual., PR - Patient Responsibility - We could bill the patient for this denial however please make sure that any other rejection reason not specified in the EOB. Same denial code can be adjustment as well as patient responsibility. For example PR 45, We could bill patient but for CO 45, its a adjustment and we can't bill the patient., To increase the number of claims that successfully process and enhance cash flow, we are providing you with the top reasons claims were returned as unprocessable (RUC) with tips and resources to help you avoid many of these errors., Description: Denial code CO 107 refers to “The related or qualifying claim/service was not identified on this claim.” This means that the submitted claim is missing information about a related or qualifying service necessary for proper adjudication. Common Reasons for the Denial CO 107: Next Steps: How to Avoid Denial CO 107 in the Future:, Medicaid Claim Denial Codes N1 - N50 N1 You may appeal this decision in writing within the required time limits following receipt of... CPT 80053, Comprehensive metabolic panel CODE DESCRIPTION 80053 Comprehensive metabolic panel This panel must include the following: Albumin (82040), Bilirubin, total (822..., Denial code co - 50 : These are non covered services because this is not deemed a "medical necessity" by the payer. Explanation and solution : It means that Medicare thinks that the submitted procedure not required to perform. Check the DX or submit the claims with Medical records. Glycosylated Hemoglobin A1C: Medical Necessity Denials, 144 Incentive Adjustment e.g. preferred product / service (Used when there are claims level provider incentive payments) 161 Provider Performance bonus (Used when there are claims level provider bonus payments) 45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement (Use Group Code PR or CO depending upon ..., WPC - Remittance Advice Remark Codes (RARCs) - Used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing. Each RARC identifies a specific message as shown in Remittance Advice Remark Code List. Last Updated Fri, 30 Sep 2022 18:52:51 +0000., ex49 49 m86 deny: these are noncovered services because this is a routine exam ... code not covered by ohio medicaid do not bill member ex4n 16 m76 deny: diagnosis code 19 missing or invalid ... ex6l 16 n4 eob incomplete-please resubmit with reason of other insurance denial . ex6m 16 n252 attending npi not submitted on claim ex6n 16 m119 deny ..., Sep 30, 2022 · ANSI Codes. American National Standard Institute (ANSI) codes are used to explain the adjudication of a claim and are the CMS approved ANSI messages. Group codes must be entered with all reason code (s) to establish financial liability for the amount of the adjustment or to identify a post-initial-adjudication adjustment. , Denial Reason, Reason/Remark Code(s) PR-204: This service/equipment/drug is not covered under the patient’s current benefit plan. PR-49: These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. CPT code: 36415. Resolution/Resources, Ans. The medicare 204 denial code is quite straightforward and stands for all those medicines, equipment, or services that are not covered under the claimant’s current insurance plan. Q2. Can I contact the insurance company in case of a wrong rejection? Ans. Yes, you can always contact the company in case you feel that the rejection was ..., Reason Code: Enter the Claim Adjustment Reason Code as received from the other payer. ... 49, 50, 55, 75, 76, 77, 90, 91, 107, 108, 109, 122, 123, 132, 138, 142 ..., Common Reasons for Denial. Claim is missing a Certification of Medical Necessity or DME Information Form (Required for dates of service prior to January 1, 2023 only) Documentation requested was not received or was not received timely. Item billed may require a specific diagnosis or modifier code based on related LCD., Reason Code 114: Transportation is only covered to the closest facility that can provide the necessary care. Reason Code 115: ESRD network support adjustment. Reason Code 116: Benefit maximum for this time period or occurrence has been reached. Reason Code 117: Patient is covered by a managed care plan. , Medicare Denial Codes. PR 1 Deductible Amount PR 2 Coinsurance Amount PR 3 Co-payment Amount OA 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. ... (Use Group Codes PR or CO depending upon liability). CO 49 These are non-covered services because this is a routine exam or screening procedure done in ..., Reason codes, and the text messages that define those codes, are used to explain why a ... 49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. ... 64 Denial reversed per Medical Review. 65 Procedure code was incorrect. This payment reflects the correct code., Eligible and Non-eligible codes have been converted to side-by-side listings of the codes and descriptions labeled as Covered Services and Non-covered Services, respectively. January 2012 . There are a number of enhancements that have been added to the ePACES application that you should keep in mind while working in the system: •, 1. Claim. Adjustment. Amount. ADJ AMT. This is the adjustment amount associated to the adjustment grouping code and reason code. ... PR Patient Responsibility., PR - Patient Responsibility denial code list, PR 1 Deductible Amount PR 2 Coinsurance Amount PR 3 Co-payment Amount PR 204 This service/equipment/drug is not covered under the patient’s current benefit plan PR B1 Non-covered visits. PR B9 Services not covered because the patient is enrolled in a Hospice. We could bill the patient for this denial however please make sure that any other ... , Reason for Occurrence : This denial occurs when a claim is billed with a routine diagnosis. Diagnosis codes that start with 'Z' are routine ...