Denial claim example

Denied EOB




The below picture is correct example for denial claims. Whenever the claim is denied or your receive the denial claims, you shoud check the Claim adjustment code or Denial reason code in order to work on the claims.

If you see the below EOB the denial reason code given as PI - A7 and PR - 31. See the Green Mark.

If you see the bottom of the EOB, explanation given for claim denial reason.

Important thing was find the correct reason for claim denial.

Denial claim - More reasons



Here there are two reason code has give as denial reason. But the main reason is PR - 31 which is 'Claim
denied as patient can't be identified as our insured.

Check the patient details including patient name and id number if any changes required submit the claim with required modification or call the patient and get the correct information.

If nothing worked for you bill the patient finally.


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