Denial Reason Codes - Minnesota Dept. of Health

Denial Reason Codes

Medical claim denials are listed on the remittance advice (RA) either as numbers or a combination of letters and numbers. Below are the four most commonly used denial codes:

  1. Claim status category codes
  2. Health care claim status codes
  3. Claim adjustment reason codes
  4. Remittance advice remarks codes
  • WPC: Claim Status Category Codes
    Indicate the general category of the status (accepted, rejected, additional information requested, etc.), which is then further detailed in the Claim Status Codes. Attention: Non-MDH link
  • WPC: Claim Adjustment Reason Codes
    Communicates an adjustment, which means they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim, there is no adjustment reason code. Attention: Non-MDH link
  • WPC: Remittance Advice Remarks Codes
    Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Codes (CARC) or to convey information about remittance processing. Attention: Non-MDH link

Updated Friday, October 09, 2015 at 01:20PM