| PR-1 | Deductible Amount
(also CO-1, OA-1)
| → |
| PR-2 | Coinsurance Amount
(also CO-2)
| → |
| PR-3 | Co-payment Amount
(also CO-3)
| → |
| CO-19 | Workers' Compensation Claim | → |
| CO-20 | Liability Carrier Responsible | → |
| CO-21 | No-Fault Carrier Responsible | → |
| CO-22 | Care Covered by Another Payer (COB) | → |
| CO-24 | Charges Covered Under Capitation or Managed Care | → |
| OA-53 | Payment Adjusted Due to Prior Payer Adjudication | → |
| CO-74 | Indirect Medical Education Adjustment | → |
| CO-75 | Direct Medical Education Adjustment | → |
| CO-76 | Disproportionate Share Adjustment | → |
| PR-85 | Patient Interest Adjustment | → |
| CO-89 | Professional Fees Removed from Charges | → |
| CO-94 | Processed in Excess of Charges | → |
| CO-96 | Non-Covered Charges
(also PR-96, OA-96)
| → |
| OA-100 | Payment Made to Patient/Insured | → |
| CO-101 | Predetermination: Anticipated Payment | → |
| CO-102 | Major Medical Adjustment
(also PR-102, OA-102)
| → |
| CO-104 | Managed Care Withhold | → |
| OA-105 | Tax Withholding Amount | → |
| OA-121 | Indemnification Adjustment | → |
| CO-122 | Psychiatric Services Reduction | → |
| CO-131 | Claim-Specific Negotiated Discount | → |
| CO-132 | Prearranged Demonstration Project Adjustment | → |
| CO-134 | Technical Fees Removed | → |
| OA-137 | Regulatory Surcharges, Assessments, or Health-Related Taxes | → |
| PR-142 | Monthly Medicaid Patient Liability Amount | → |
| CO-144 | Incentive Adjustment for Preferred Product/Service | → |
| CO-147 | Provider Contracted/Negotiated Rate Expired or Not on File | → |
| OA-155 | Patient Refused the Service/Procedure | → |
| CO-157 | Service Denied — Provided Due to Act of War | → |
| CO-158 | Service Provided Outside the United States | → |
| CO-159 | Service Provided as Result of Terrorism | → |
| CO-160 | Benefit Exclusion — Activity-Related Injury/Illness
(also PR-160, OA-160)
| → |
| CO-161 | Provider Performance Bonus | → |
| CO-163 | Attachment/Documentation Not Received | → |
| CO-164 | Attachment/Documentation Not Received Timely | → |
| CO-166 | Payer's Plan Responsibility Ended | → |
| CO-167 | Diagnosis Not Covered
(also PR-167, OA-167)
| → |
| CO-169 | Alternate Benefit Provided
(also PR-169, OA-169)
| → |
| CO-170 | Payment Denied — Provider Type Not Eligible
(also PR-170, OA-170)
| → |
| CO-178 | Spend Down Requirements Not Met
(also PR-178, OA-178)
| → |
| OA-192 | Non-Standard COB Adjustment Code | → |
| PR-201 | Workers' Comp Settlement — Patient Responsibility per Agreement | → |
| CO-202 | Non-Covered Personal Comfort or Convenience Services | → |
| CO-203 | Discontinued or Reduced Service | → |
| OA-209 | Regulatory Non-Collectible Amount | → |
| CO-212 | Administrative Surcharges Not Covered | → |
| PR-227 | Patient/Insured Information Not Provided | → |
| PR-247 | Professional Service Deductible on Institutional Claim | → |
| PR-248 | Professional Service Coinsurance on Institutional Claim | → |
| CO-260 | Medicaid ACA Enhanced Fee Schedule Adjustment
(also OA-260)
| → |
| CO-269 | Anesthesia Not Covered for This Service
(also PR-269)
| → |
| CO-304 | Benefits Not Available — Submit to Hearing Plan
(also OA-304)
| → |
| CO-305 | Claim Forwarded to Hearing Plan
(also OA-305)
| → |
| CO-308 | Contracted Funding Agreement Adjustment | → |
| CO-A5 | Medicare PPS Capital Cost Outlier Amount
(also OA-A5)
| → |
| CO-B10 | Allowed Amount Reduced — Component Already Paid
(also OA-B10)
| → |
| CO-B11 | Claim Transferred to Proper Payer
(also OA-B11, PR-B11)
| → |
| CO-B12 | Services Not Documented in Medical Records
(also OA-B12)
| → |
| CO-B13 | Previously Paid Service
(also OA-B13)
| → |
| CO-B14 | Only One Visit Per Physician Per Day Covered
(also OA-B14)
| → |
| CO-B15 | Qualifying Service/Procedure Not Received
(also OA-B15)
| → |
| CO-B16 | New Patient Qualifications Not Met
(also OA-B16)
| → |
| CO-B20 | Service Furnished by Another Provider
(also OA-B20)
| → |
| CO-B22 | Payment Adjusted Based on Diagnosis
(also PR-B22, OA-B22)
| → |
| CO-B23 | Procedure Not Authorized per CLIA Proficiency Test
(also OA-B23)
| → |
| CO-B4 | Late Filing Penalty
(also OA-B4)
| → |
| CO-B7 | Provider Not Certified/Eligible
(also PR-B7, OA-B7)
| → |
| CO-B8 | Alternative Services Not Utilized
(also OA-B8)
| → |
| CO-P1 | State Mandated Requirement — Property and Casualty
(also OA-P1)
| → |
| OA-P10 | Payment Reduced to Zero Pending Litigation | → |
| OA-P11 | P&C Claim Disposition Pending Litigation | → |
| CO-P12 | Workers' Compensation Jurisdictional Fee Schedule Adjustment | → |
| CO-P13 | Workers' Compensation Jurisdictional Regulation Adjustment | → |
| CO-P14 | Benefit Included in Another Same-Day Service | → |
| CO-P15 | Workers' Compensation Medical Treatment Guideline Adjustment | → |
| CO-P16 | Provider Not Authorized to Treat Injured Workers | → |
| CO-P2 | Non-Work Related Injury/Illness | → |
| PR-P3 | Workers' Compensation Case Settled — Patient Responsibility | → |
| CO-P4 | Workers' Compensation Claim Non-Compensable | → |
| CO-P5 | Reasonable and Customary Fee Adjustment (No Legislated Maximum) | → |
| CO-P6 | Benefits Entitlement Adjustment | → |
| CO-P7 | Billed Code Not in Fee Schedule/Database | → |
| OA-P8 | Claim Under Investigation | → |
| CO-P9 | No CPT/HCPCS Code Available for Service | → |