Medical Review Denial Tool

This tool allows you to quickly obtain additional details relating to complex and noncomplex medical review denials instead of spending unnecessary time contacting the Provider Contact Center for the exact same information. This tool will help assist you with:

• Medical Review denial explanations for the following ANSI Codes:
  • ANSI CO-50 with ANSI Remark Code N109, claims reviewed on or after 1/14/14
  • ANSI CO-50 with ANSI Remark Codes N109 and N115, claims reviewed on or after 1/14/14
  • ANSI CO-50 with ANSI Remark Code N102, claims that have been processed on or after 1/1/15
• Comparative Billing Analysis
  • Ability to compare your organization's Past 90 day and Days 91-180 denial rate for claims in the same policy group compared to your peers.
  • Claim denial explanation breakdowns showing your total number of denials for this reason compared to the average of your peers for the past 90 days. (Note: This feature will only show your breakdown count for claims dating back 90 days)
  • Snap shot of your top 5 overall denial reasons along with your peers for the specific policy group.

To Use: Enter the 14-digit CCNICN in the CCN form field and select Submit. Select Reset to enter information for a new CCN.