5 Common Medical Billing Denial Codes and How to Fix Them

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Swipe to learn more! Understanding hashtag#MedicalCoding and knowing how to resolve denials is crucial for smoother claim processing and fewer rejections.

➡ Swipe to uncover the most common medical billing denial codes and expert solutions to fix them.
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1. Common Medical
Billing Denial Codes
LEARN HOW TO FIX THEM
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2. CO-11 Diagnosis &
Procedure Conflict
This denial occurs when the diagnosis does not justify the
procedure performed. Insurance providers require
medical necessity to be clearly demonstrated through
proper coding.
Verify diagnosis and procedure codes before
submitting claims.
Use EHR validation tools to detect code mismatches.
Perform internal audits to identify discrepancies early
and avoid denials.
How to Fix it?
# 1
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3. CO-16 Rejection
Nothing halts a claim faster than missing critical details
like patient demographics, provider credentials, or prior
authorizations.
Use automated claim scrubbing software to identify
missing fields.
Create a pre-submission checklist to verify required
information.
Train billing staff to cross-check claim forms with
insurance policies.
How to Fix it?
# 2
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4. CO-18 – Duplicate Claim
Submission
Insurance companies hate receiving the same claim twice
—it slows processing and often leads to automatic
rejection.
Implement duplicate claim detection in your billing
software.
Keep a clear record of previously submitted claims to
avoid redundant entries.
If a resubmission is necessary, include documentation
explaining why.
How to Fix it?
# 3
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5. CO-29 Late Filing Denial
Timeliness is everything in medical billing. Every
insurance provider has a strict deadline for claim
submissions. If you miss it, your claim is automatically
rejected.
Set automated reminders to track payer-specific
deadlines.
Submit claims as soon as possible to allow time for
corrections.
If denied, file an appeal with proof of timely filing, such
as electronic submission receipts.
How to Fix it?
# 4
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6. CO-197 -Preauthorization
Required
Insurance companies hate receiving the same claim twice
—it slows processing and often leads to automatic
rejection.
Always check preauthorization requirements before
scheduling procedures.
Maintain a dedicated preauthorization team to manage
approvals.
Use real-time eligibility verification tools to confirm
insurance requirements.
How to Fix it?
# 5
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Practice Audit
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