Denials split roughly into eligibility, authorisation, coding and pricing. Drug denials cluster in coding and pricing: wrong units, missing NDC, missing invoice, non-covered under the benefit.
A code on a remittance advice explaining why a claim or line was not paid as billed.
Denials split roughly into eligibility, authorisation, coding and pricing. Drug denials cluster in coding and pricing: wrong units, missing NDC, missing invoice, non-covered under the benefit.