ATB_AUTH_DENIAL_RSNS

Description: |
This table contains the reasons for denial when the authorization decision is denied.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
AUTH_BUNDLE_ID | 1 |
LINE | 2 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | AUTH_BUNDLE_ID | NUMERIC | No |
The unique identifier (.1 item) for the auth bundle record.
2 | LINE | INTEGER | No |
The line number for the information associated with this record. Multiple pieces of information can be associated with this record.
3 | AUTH_PYR_DENIAL_REASON_C_NAME | VARCHAR | No |
The reasons for the denial status received from the payer. Only relevant when the payer decision is denied.
May contain organization-specific values: No
Category Entries:
Not Medically Necessary
Retroactive Referral Request
Not a Covered Benefit
Not in Network
Duplicate Referral Request
System Automatically Denied
Does Not Meet 3rd Party Guidelines
DOES NOT MEET INTERNAL GUIDELINES
Member not covered
Authorized Quantity Exceeded
Exceeds Plan Maximums
No Prior Approval
Requested Information Not Received
Service Inconsistent With Diagnosis
Pre-Existing Condition
Patient is Restricted to Specific Provider
Plan/Contractual Guidelines Not Followed
Plan/Contractual Geographic Restriction
Inappropriate Facility Type
Once in a Lifetime Restriction Applies
Transport Request Denied
Errors in the Request
Excluded Benefit
Appeal Denied
Not Primary Care Physician
Level of Care Not Appropriate
Denial Response Needs Review
Requires Medical Review
Experimental Service or Procedure
Peer to Peer Needed
Time Limits not Met