Eligibility not active
The reviewing plan says its records did not show active coverage for the date of service.
Read what eligibility not active meansPublic reference
Claim denial reasons: 10 priority categories
A denial category is a plain-English label for the pattern shown by the submitted claim fields and the payer's message. It helps you organize what you are reading; it is not a payer rule, a code list, or a prediction about what happens next.
These are the ten priority categories taught in The Remit Lab. Each free page explains the meaning, the beginner mistake that can blur it, and the cues you can look for on a claim or explanation of benefits. Complete correction paths, practice scenarios, quizzes, checklists, templates, and tools remain inside the training product.
These ten are the lab's priority starting set, not a complete denial taxonomy. Examples outside it include bundling and NCCI edits, denials based on a non-covered benefit or contractual exclusion, and cases where a benefit is exhausted. Records requests can accompany many denial types; the lab therefore treats a records request as a cross-cutting event, not a denial category.
Browse the ten priority categories
Eligibility not active Missing prior authorization Missing prior authorization
The reviewing plan says it did not find an advance-approval record that matched the submitted date or service.
Read what missing prior authorization meansTelehealth billing mismatch Telehealth billing mismatch
The reviewing plan says the claim fields describing the location, telehealth method, and service do not agree.
Read what telehealth billing mismatch meansFrequency limit exceeded Frequency limit exceeded
The reviewing plan says the submitted service went beyond a visit or unit limit stated for the relevant period.
Read what frequency limit exceeded meansMedical necessity Medical necessity
The reviewing plan says the record it reviewed did not meet its clinical criteria for the submitted service.
Read what medical necessity meansTimely filing Timely filing
The reviewing plan says it received the claim after the filing window stated for that claim.
Read what timely filing meansCoordination of benefits Coordination of benefits
The reviewing plan says another coverage should process the submitted claim before it does.
Read what coordination of benefits meansIncorrect payer/member ID Incorrect payer/member ID
The receiving plan says it could not match the submitted payer or member ID to its records.
Read what incorrect payer/member id meansProvider not credentialed / out-of-network Provider not credentialed / out-of-network
The reviewing plan says its records did not show the rendering provider in the expected enrollment or network status for that service date.
Read what provider not credentialed / out-of-network meansDuplicate claim Duplicate claim
The reviewing plan says the submitted claim appears to match one already in its system.
Read what duplicate claim means