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