Aetna Denial

D55 - Timely limit for filing has expired.





Appealed the claim with clearing house acceptance report.


D28 - Aetna is not responsible for these charges. if there is no valid referral the member is responsible.



Get the referral from PCP and file the claim.

D62 - Claims are denied because procedure was not re certified.


Claim refiled with the auth# and got paid.


DMC - There is insufficient information to determine if other health coverage exists. An
inquiry was sent to the member.


Patient has to update the COB information to Aetna.

1 - Our records indicate that the member’s coverage terminated before you provided this services. The member is responsible for this charge(s).




Secondary balance billed to patient.

.
D82 - The patient’s medical history information has not been received for pre-existing determination.


If information required from provider then Refile with medical notes and received payments.


DPC - Member must contact the customer service area to select a primary care physician.


Sent for patient calling and requested him to update his PCP. After updated the PCP details got payment.


D30 - Charge is denied. Service/procedure is considered incidental/inclusive to the primary procedure or OV/Hosp consult fee


Added modifier and refiled the corrected claim.


N174 - This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group PR.


Bill patient or take W O.


D16 - These charges are the result of an Auto Accident. Please bill the appropriate Auto insurance carrier.


Sent for patient calling and got the auto insurance information after that claim filed to the concerned insurance.

Medical billing process
Insurance claims timely filing limit
Aetna address and phone numbers
Medical billing denial - coding error

Insurance claim denied
Denial claim example
Health insurance claim denials
Insurance denial appeal letter
Denial claim

1 comment:

Indradevi said...

Dear Sir,
Being a fresher in Coding profession, i found your blog extremely useful and informative. Thanks for your work and please continue updating your blog with latest information.

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