Reason Code C5469

Reason Code Narrative

SERVICE IS SUBJECT TO PRIOR AUTHORIZATION AND NO UTN IS PRESENT ON THE CLAIM. THE PROGRAM INDICATOR AND ITEM/SERVICE DO 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

 

Last Updated Aug 30 , 2022