Pxn Networx Std Fee Schedule (2025)

FAQs

What does denial code PXN mean? ›

If your claim was erroneously paid or denied, it may have included the following remittance. explanation code: Exp. code Text. PXN.

Denial code 272 is used when the coverage or program guidelines set by the insurance provider were not met. This means that the services or procedures performed may not be covered under the patient's insurance plan due to specific limitations or requirements outlined by the insurance company.

Common causes of code N479 (Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer)) are incomplete submission of patient's insurance information, failure to attach the Explanation of Benefits (EOB) document from the primary payer when billing the secondary payer, or incorrect processing ...

ICD-10-CM Code H63-H67: Other Disorders of the External Ear. Apart from inflammation, the external ear can be affected by many other disorders, all of which demand precise coding for accurate identification and effective treatment.

Denial code 27 means that the expenses were incurred after the coverage for the specific service or treatment had already ended. This code indicates that the insurance company will not provide reimbursement for the expenses incurred during this period.

Denial code 102 is a Major Medical Adjustment that indicates a claim has been denied or adjusted due to a significant medical reason.

When a claim processes with claim adjustment reason code PR104 for Managed Care Withholding, this typically occurs on Blue Options policies when the provider is not participating on the BluePreferred PPO network or on regular policies when the provider is not in the member's specific network.

Denial Reason PR-22 means that payment adjusted because this care may be covered by another payer per coordination of benefits.

177 Patient has not met the required eligibility requirements.

PR-40 Code – Charges Do Not Meet Qualifications For Emergent/Urgent Care This denial suggests the billed service doesn't qualify as emergent or urgent. PR-55 Code – Invalid Procedure Code/Modifier Used Much like the PI-4 code, this code indicates a procedure or modifier inconsistency.

What is a 210 denial code? ›

Denial code 210 is used when a payment is adjusted because the pre-certification or authorization for a healthcare service or procedure was not received in a timely fashion.

Denial code B13 is for previously paid claims. It means that payment for this service may have already been provided in a previous payment.

4720: Other secondary chronic gout, left ankle and foot, without tophus (tophi)

HCPCS Code for Hospital outpatient clinic visit for assessment and management of a patient G0463.

Reason code 34963 indicates the attending physician on the claim is invalid or not present in the PECOS Enrolled Physicians file, or the attending physician NPI is present on the PECOS Enrolled Physicians File, but the first four digits of the last name do not match, or the claim has a Through Date of service equal or ...

Denial codes provide specific explanations for why a claim was rejected, allowing healthcare providers and billing professionals to understand the basis for the denial and take appropriate action to resolve the issue.

What is a reason code used on an EOB? Reason codes appear on an explanation of benefits (EOB) to communicate why a claim has been adjusted. If there is no adjustment to a claim/line, then there is no adjustment reason code.

Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. Each RARC identifies a specific message as shown in the Remittance Advice Remark Code List.

The CO 24 denial code is used to indicate that the claim made has been denied due to the patient's insurance coverage under a capitation agreement or a managed care plan.