The Top 5 Denial Codes—and What to Do About Them

Let’s talk about dreaded denial codes. They arrive in your mailbox like a parking ticket—short, a bit cryptic and actually pretty accusatory. As much as we don’t like them, denial codes are actually clues. They tell you exactly what the payer didn’t like—and if you learn to read them, you can build stronger appeals, fix submission errors faster, and hopefully prevent repeat denials altogether.

That’s where FightPaperwork.com really shines. Make sure you check out the latest demo. You will see one thing that is very clear: the platform isn’t just for managing paperwork; it’s a tool to help you fight denials. It helps you figure out what documentation is missing and then generates the right format for your appeal (letter, note, or combo) based on the issue and payer.

Let’s look at the top five denial codes you’re probably seeing, and how to fight them more effectively and efficiently.

1. CO-197: Precertification/Authorization Missing

Translation: You forgot to get prior auth, or the payer thinks you did.

What To Do:

• Double-check whether the procedure or medication actually required precert.
• If it did, and there was no authorization, check if a retroactive PA is allowed.
• If you submitted it and it was “lost,” resubmit with timestamped documentation.
• Attach a timeline summary and brief letter explaining the situation.

How FightPaperwork Helps:
The platform walks you through the requirements and auto-generates a retro-authorization request with proper formatting based on the service and payer type.

2. CO-50: Non-Covered Service

Translation: The patient’s insurance plan doesn’t include this service—or they say it’s not medically necessary.

What To Do:

• Review the plan’s medical policy.
• Submit an LMN citing clinical guidelines and include current evidence-based criteria (e.g., ADA, NCCN, ACOG).
• Explain why the service is essential for this patient’s specific condition and why no alternative applies.

How FightPaperwork Helps:
Just answer guided prompts about prior treatment, diagnosis, and plan of care. The system will generate a custom appeal letter with clinical justification and payer-specific language.

3. CO-16: Missing/Incomplete Information

Translation: You didn’t submit something they wanted, but they don’t clearly state that.

What To Do:

• Call the payer or check their portal for missing documentation notices.
• Review your original submission. Ensure you include everything necessary (labs? imaging? specific codes?).
• Resubmit with a cover letter and updated attachments.

How FightPaperwork Helps:
The platform tracks what you submitted and can flag what’s often missing based on the denial code, then walks you through a checklist to fill in the gaps. It generates the revised documentation so you don’t waste time rewriting or guessing if you have included what is needed for approval.

4. CO-151: Information Doesn’t Support Level of Service

Translation: The documentation didn’t justify the complexity or necessity of what you billed for care delivery.

What To Do:

• Reframe your clinical note or LMN to show why the patient’s condition meets the level of care.
• Emphasize severity, functional impact, failed alternatives, and risks to the patient’s health in a continued delay of care.
• Include objective measures—labs, imaging, scoring systems, etc.

How FightPaperwork Helps:
The platform builds your justification step-by-step. Based on your answers, it will generate a revised progress note or targeted LMN that spells out the rationale in a format payers prefer to help them make a decision.

5. CO-B7: Provider Not Eligible for This Service

Translation: Something’s off with your NPI, taxonomy, or credentials.

What To Do:

• Check NPI, TIN, and credentialing status with the payer.
• Resubmit using correct billing info or escalate to provider services for update.
• If appropriate, submit a correction request or secondary appeal.

How FightPaperwork Helps:
This one’s often about organization. FightPaperwork lets you store credentialing info, NPIs, and billing details by provider so you can avoid mismatches and auto-fill corrected documentation.

How Denial Codes Turn Into Learning Tools

Every denial code is a chance to make your workflow processes even stronger. FightPaperwork.com doesn’t just help you appeal the current case; it gives you insight and visibility into patterns, so you can fix the root cause of your continued denials. It’s time to build a reusable justification template and cite the payer’s policy in advance. With FightPaperwork, all of that becomes trackable. And the appeal documents aren’t just clean—they’re auto-built based on what works.

Final Takeaway

Denials are part of the system. But how you respond—how fast, how clearly, how confidently—makes all the difference. FightPaperwork.com isn’t just here to help you “submit better claims.” It’s here to help you submit more effectively and efficiently. With guided question flows, dynamic formatting, and code-aware appeal generation, it’s the closest thing to having an AI-powered clinical documentation expert in your corner.

Danielle-Miller, RN
Doctorate-Level Nursing Expert | Healthcare Consultant | Academic Advisor _