Denial code 1 is related to the deductible amount. It indicates that the claim has been denied because the patient has not met their deductible for the specific service or treatment. This means that the insurance company will not cover the cost of the claim until the patient has paid the required deductible amount out of pocket.

Denial code 2 means that the insurance company is denying the claim because the patient has not paid their required coinsurance amount. The coinsurance amount is the portion of the medical bill that the patient is responsible for paying out of pocket, after the insurance company has paid their portion. In this case, the denial code indicates that the patient has not fulfilled their financial obligation, resulting in the denial of the claim.

Denial code 3 indicates that the claim has been denied due to an issue with the co-payment amount. This means that the patient's co-payment, which is the fixed amount they are responsible for paying out-of-pocket for a specific healthcare service, has not been correctly calculated or included in the claim. As a result, the claim has been denied and will need to be corrected and resubmitted with the accurate co-payment amount.

Denial code 4 is used when the procedure code is inconsistent with the modifier that was used. This means that the modifier attached to the procedure code does not match the requirements or guidelines set by the payer. To understand the specific reason for the denial, it is recommended to refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) if it is present in the claim.

Denial code 5 means that the procedure code or type of bill submitted is not consistent with the place of service where the service was provided. In other words, the code or bill does not match the location where the service was performed. To understand the specific reason for this denial, you can refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) in the electronic remittance advice (ERA) if it is available.