Category summary: Focus on the plan’s appeal rules, date stamps, confirmations, and any good-cause or payer-error exception.
Top codes in this category
CO-95Plan procedures not followedCO-193Original payment decision maintained after reviewCO-285Appeal procedures not followedCO-286Appeal time limits not met
How to work these denials
- Find the plan’s appeal/dispute instructions and deadline for the product.
- Assemble proof of original appeal submission, portal confirmation, fax confirmation, or mail tracking.
- Explain why the submission met the procedure or why a documented exception applies.
- Separate procedural reinstatement requests from the underlying clinical or coding merits.
- Escalate through provider relations only with a complete date-stamped packet.
Evidence checklist
- Appeal instructions
- Submission confirmation
- Fax/mail/portal proof
- Denial letter
- Provider contract or manual excerpt
- Timeline