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Tips for Resubmitting Denied Claims

The table below provides codes and descriptions that may appear when checking claim status online or on your remittance advice. Use this list to expedite any correction or reprocessing needed. Refer to the applicable denial reason for tips on resubmitting the claim.

HNFS will accept claims for review or reconsideration under the following circumstances:     

  • Care was authorized by HNFS and rendered prior to Sept. 30, 2019, and
  • the reconsideration request is submitted within 90 days of the last remittance advice date.

Contact HNFS' Provider Services to request additional information on how to submit a reconsideration request. HNFS cannot consider requests received outside this 90-day window. 
 

Code Code Description Tips for Resubmission
DUPXX Claim denied as duplicate The service billed has previously been processed, therefore this claim is denied as a duplicate. Verify the date of service and services rendered have not been previously submitted. 
HN0001 Medical documentation not on file Resubmit claim with medical documentation (applies to PCCC only).
HN0003 Medical Documentation Incomplete Resubmit claim with complete medical documentation (applies to PCCC only)
HN EXPIRED Expired or Termed code The code used on the claim is not a valid code. Please review the code and resubmit the claim with a billable code. Visit www.cms.gov for code validation.
HNNOENRL Patient is eligible, but no auth on file An authorization is not on file for the date of service. If you feel the claim has been denied in error, resubmit the claim with the veteran’s Social Security number (SSN) or EDIPI and full authorization number. Visit our Authorization Requirements page to learn more.
HNNOPT Patient is not active for the program The patient is not eligible for VCP/PCCC services. If you feel the claim has been denied in error, validate the authorization to determine if the authorization was sent through direct care VA. Claim should be submitted to VA for review.
QC0015 Duplicate claim line The service billed has previously been processed, therefore this claim is denied as a duplicate. Verify the date of service and services rendered have not been previously submitted.
QC0590 COB information required The veteran has other health insurance (OHI) for non-service connected care, and the commercial OHI is the primary payer. Resubmit the claim with OHI EOB information. (This denial applies to dates of service prior to 4/20/2017.)
QC0592 No COB amount on claim line The veteran has other health insurance (OHI) for non-service connected care, and the commercial OHI is the primary payer. Resubmit claim with the OHI EOB information. (This denial applies to dates of service prior to 4/20/2017.)
QC0623 No effective eligibility for DOS found An authorization is not on file for the date of service. If you feel the claim has been denied in error, resubmit the claim with the veteran’s SSN or EDIPI and full authorization number.
QC2516 Authorization required for claim but not found An authorization is not on file for the date of service. If you feel the claim has been denied in error, resubmit the claim with the veteran’s SSN or EDIPI and full authorization number.
QC3026 No eligible visits remaining for authorization The veteran has used all of his/her authorized visits. For future services, visit our Requesting Authorization for Additional Services page for more information.