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Denial Code |
Description | Payer Details |
| 29 | The time limit for filing has expired | Each payer has different timely filing rules. The claim was submitted after that date. Please remember to complete the BSQ timely (including addressing any tracking errors) and provide enough time for the claim submission process that happens every Tuesday. |
| 177 | Patient has not met eligibility requirements | AmidaCare denial. System configuration issue-already in a project for reprocessing |
| 197 | Precertification/authorization/notification/pre-treatment absent | Precertification is not required for Health Home services. Healthfirst's system automatically denies these claims due to a configuration issue-their team reviews manually. It takes about 4-6 weeks from the initial denial. Please ignore these, as they will be reprocessed. |
| MA39 | Missing/incomplete/invalid gender | EMedNY denial- FCM reviews, corrects and resubmits on a monthly basis going back 1 year. |
| MA66 | Missing/incomplete/invalid principal procedure code | CANS denials from Healthfirst. Healthfirst's system automatically denies these claims due to a configuration issue-their team reviews manually. It takes about 4-6 weeks from the initial denial. Please ignore these, as they will be reprocessed. |
| N4 | Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB | Inappropriate denial. Healthfirst's system automatically denies these claims due to a configuration issue-their team reviews manually. It takes about 4-6 weeks from the initial denial. Please ignore these, as they will be reprocessed. |
| N130 | Consult plan benefit documents/guidelines for information about restrictions for this service | Inappropriate denial from Healthfirst. Coordination of Benefits issue on payer's end. Healthfirst's system automatically denies these claims due to a configuration issue-their team reviews manually. It takes about 4-6 weeks from the initial denial. Please ignore these, as they will be reprocessed. |
| 27 / N30 | Expenses incurred after coverage terminated/ Patient ineligible for this service |
UnitedHealthcare denial. Coordination of Benefits issue on payer's end. Payer reprocesses on their own. Nothing needs to be done. Please ignore these, as they will be reprocessed. |
| N30 | Patient ineligible for this service |
Metroplus denial due to Coordination of Benefits issue impacting dual-eligible Metroplus members. Metroplus has not been reprocessing these claims at all due to a system issue. An official complaint to State has been initiated by FCM on 1/23/24. Case Number: BCS-135911 |
| N340 | Missing/incomplete/invalid subscriber birth date | EMedNY denial- FCM reviews, corrects and resubmits on a monthly basis going back 1 year. |
| N383 | Not covered when deemed cosmetic | Inappropriate denial. Healthfirst's system automatically denies these claims due to a configuration issue-their team reviews manually. It takes about 4-6 weeks from the initial denial. Please ignore these, as they will be reprocessed. |
| N425 | Statutorily excluded service(s) | Inappropriate denial. If payer is UnitedHealthcare issue is on payer's end. Payer reprocesses on their own. Nothing needs to be done. Please ignore these, as they will be reprocessed. |
| N650 | This policy was not in effect for this date of loss. No coverage is available | Inappropriate denial from Healthfirst. Coordination of Benefits issue on payer's end. Healthfirst's system automatically denies these claims due to a configuration issue - their team reviews manually. It takes about 4-6 weeks from the initial denial. Please ignore these, as they will be reprocessed. |
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If you are seeing these denial codes for another payer not listed please reach out to the Help Desk for review. fcm-support@footholdtechnology.com |
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