Whenever claim denied as CO 96 – Non Covered Charges it may be because of following reasons:
- Diagnosis or service (CPT) performed or billed are not covered based on the LCD.
- Services not covered due to patient current benefit plan.
- It may be because of provider contract with insurance company.
So when you come across CO 96 – Non Covered Charges, the first thing is to check the remarks code listed with that denial to identify the correct denial reason.
Let us see some of the important remark codes:
| Remark Codes | Reason | Solution |
| N180 or N56 | It indicates wrong Dx code was used on the claim for the CPT code Billed. | First check LCD to confirm that the procedure code billed is covered and also check whether any modifier is missing. |
| N115 | It indicates that the claim was denied based on the LCD submitted | Next check with coder and resubmit the claim with correct DX code which is listed under LCD. |
| M114 | The Beneficiary may be in a competitive bidding area you are not contracted with |
A procedure code that is truly a non-covered item should deny with a “PR” prefix.
Or else the best way to find out the exact denial is to call the claims department of that particular insurance with the following question in order to rectify and resolve the problem.
CO 96 – Non Covered Charges |
| 1 | May I know the Claim received date | |
| 2 | May I know the claim was denied | |
| 3 | Check in the application whether we received any payment for the previous DOS | if yes clarify with ins rep else next question |
| * | If Yes | If No |
| 4 | Provide the information to the rep and send the claim back for reprocess | May I know whether the procedure code is Non Covered or Diagnosis code is Non covered |
| * | * | May I know services not covered due to provider contract or due to patient plan |
| 5 | Claim# and Cal reference# |