CO50 denial code description and corrective action

Non covered services because this is not deemed as medical necessity by the payer.

This denial occurs when the insurance does not consider the services provided to be medically necessary based on the patient’s health condition.
Sometimes, an incorrect diagnosis code is appended, which can also lead to this denial.

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, if claims in the member’s history with the same coding have been paid, and ask the representative to reprocess the claim. Be sure to note the claim number, rep name and call reference number, and then follow up on the claim after the provided TAT.
Consult coding specialists to verify whether the diagnosis is appropriate.
If they provide the correct diagnosis code, submit a corrective claim with the updated diagnosis.
Medicare does not accept corrected claims, so in the case of any denial, a new claim must always be submitted.
If the coding team confirms that the coding is accurate we proceed to submitting an appeal along with supporting documents and medical notes.
For submitting an appeal or corrective claim, we must calculate the timely filing limit starting from the processed date. If the limit has been exceeded, the claim will be denied again for exceeding the filing deadline. In such cases, we should consult with the provider. Some clients may still want us to submit the appeal or corrective claim even after the timely filing limit has passed, so we should proceed according to their instructions.