Reason Code C5460

Reason Code Narrative

ITEM OR SERVICE IS SUBJECT TO PRIOR AUTHORIZATION AND A NON-AFFIRMED DECISION IS PRESENT ON THE PRAU AUXILLARY FILE.

Common Reason Code Errors

  • Non-affirmed prior authorization request on file for service billed on the claim.

Common Reason Code Corrections

  • Auto denial
  • A redetermination request may be submitted if facility feels that sending additional documentation will support need for service(s) provided
    • Redetermination should include:
      • All applicable supporting medical documentation
      • Corrected UB-04 form

Resources

 

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