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 three most commonly used denial codes:

1. Claim status category codes
2. Claim adjustment reason codes
3. Remittance advice remarks codes

• X12: 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.
• X12: 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.
• X12: 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.