B7 denial code description and corrective action

Provider was not eligible/certified to be paid for this procedure/service on this DOS

This denial mostly occurs when the provider is not eligible to perform the billed services on the mentioned DOS.

Actions

First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.
Call the insurance company to confirm the exact denial reason and proceed accordingly.
If the claim is denied because the rendering provider’s specialty is different, then click here for further steps.
If the claim is denied because the rendering provider is not eligible to perform the services, then click here for further steps.
If the claim is denied because the referring provider is not eligible to refer for this service, then click here for further steps.
If the representative provides any other denial cause, then proceed accordingly.

Description