Claim denial checker for dietitians
By Javier Alvarez · Updated · 4 min read
| Group code | Who owes: CO and PI you, PR the patient, OA neither by default |
|---|---|
| Reason code (CARC) | Why the line was adjusted or denied |
| Remark code (RARC) | The detail: which field, which policy |
| Rejection vs denial | Rejected claims were never processed: fix and resend, nothing to appeal |
| Corrected claim | Frequency code 7 with the payer's claim number; Original Medicare uses a reopening instead |
| Typical deadlines | Medicare: 12 months to file, 120 days to appeal. Commercial: usually 90-180 days |
A denied nutrition claim tells you exactly what went wrong, in a language nobody teaches dietitians. The remit says "PI-272 N386", the clearinghouse says "A7:33", the eligibility check says "the service code is currently not supported", and you are left wondering whether it is a problem, whose problem, and how long you have. This checker translates all of it for MNT claims.
How to use the checker
- Paste what the payer sent. One code, a whole remit line, a clearinghouse rejection, or the sentence from the portal. It finds every group code, reason code, remark code and known message in it.
- Add context if you have it: the payer type, the code you billed and whether the visit was telehealth. The fix and the deadlines change with them (Original Medicare, for example, does not take corrected claims).
- Read the verdict: who owes the amount and the next step, then each code's meaning, the usual cause on a nutrition claim and the fix, with a link to the full guide.
Leave out names, member IDs and dates of birth. The checker never needs them, and nothing you type leaves your browser.
How to read a denial in 30 seconds
A line on an ERA or EOB has up to three parts:
| Part | Example | What it tells you |
|---|---|---|
| Group code | CO, PR, OA, PI | Who carries the unpaid amount |
| Reason code (CARC) | 96, 31, 272, B7 | Why the payer adjusted or denied the line |
| Remark code (RARC) | N386, MA130, N264 | The detail: which field, which policy |
CO (contractual obligation) and PI (payer-initiated) amounts are yours: in network you generally cannot bill the patient. PR (patient responsibility) is the patient's. OA is neither by default. The denial codes guide has a page for every code dietitians see often.
A rejection is different. A claim rejected by the clearinghouse or the payer's front door (a 277CA with A3, A6, A7 or A8) was never processed, so there is no decision to appeal: fix the field and send it again. Rejection vs denial explains the difference.
"The service code is currently not supported"
This one comes up in billing groups constantly, often next to a payer ID such as UnitedHealthcare's 87726. It is not a denial and not a claim. It is the answer to an electronic eligibility check: the payer's system did not return benefits for the procedure code you asked about.
That is normal for nutrition. Many payers answer electronic eligibility checks only by broad service type (health plan coverage, office visit) and do not support lookups by CPT code. Nutrition benefits also depend on things an electronic check rarely returns: the diagnosis, a visit limit, a carve-out to another company, preventive vs medical coverage.
So verify by phone (or the payer's portal chat) and ask about 97802 and 97803 specifically:
- Is MNT covered for this diagnosis (Z71.3 with the condition, E11.x, E66.x...)?
- Am I in network for this plan product?
- Visit or unit limits per year? Deductible, copay, or $0 under preventive care?
- Is telehealth covered, and with which place of service and modifier?
- Prior authorization or referral needed?
- Is nutrition carved out to another company?
Write down the date, the representative's name and the call reference number. Our verification call script has the full list.
Correct, appeal or bill the patient
| Situation | What to do |
|---|---|
| Rejected (277CA A3/A6/A7/A8) or MA130 | Fix the field and send a new claim |
| Processed, but a field was wrong (CO-4, CO-11, CO-16, PR-31) | Corrected claim: frequency code 7 with the payer's claim number. Original Medicare: reopening |
| Sent to the wrong payer (CO-109, CO-22, CO-27) | New claim to the right payer; keep the remit as proof of timely filing |
| Right claim, wrong decision (CO-50, CO-29 with proof) | Appeal with the note, the referral and the policy |
| Patient responsibility (PR-1, PR-2, PR-3, PR-204) | Bill the patient |
| Contractual adjustment (CO-45) | Post it; not a denial |
Typical deadlines
These are the usual windows; your contract or the plan's provider manual has the exact numbers.
- Original Medicare: 12 months from the date of service to file (42 CFR 424.44); redetermination within 120 days of the remit; reopening of a clerical error within 1 year.
- Commercial plans: filing usually 90 to 180 days from the date of service; provider appeals usually 60 to 180 days from the denial.
- Medicare Advantage and Medicaid: set by the plan contract or the state; Medicaid claims no later than 12 months from the date of service.
Count the days with the timely filing calculator.