Reason Code C5468

Reason Code Narrative

SERVICE IS SUBJECT TO PRIOR AUTHORIZATION AND NO UTN IS PRESENT ON THE CLAIM. A PROGRAM INDICATOR IS PRESENT. SERVICE ON THE CLAIM DOES NOT MATCH AN OCCURRENCE ON THE PRAU AUXILLARY FILE.

Common Reason Code Errors

  • Pending Prior Authorization Request (PAR) at Common Working File (CWF)

Common Reason Code Corrections

  • Auto-denial unless a valid UTN is supplied do not overturn

Resources

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Last Updated Apr 29 , 2025