DenialCodePro
279Denial CodeGeneral Adjustment

Code 279

Problem Description

Services not provided by Preferred network providers. Usage: Use this code when there are member network limitations. For example, using contracted providers not in the member's 'narrow' network.

Actionable Fix — Solution Steps

Verify claim details and patient demographics. Submit a corrected claim or appeal with necessary supporting medical documentation.

Related Codes in General Adjustment

1

Deductible Amount

2

Coinsurance Amount

3

Co-payment Amount

6

The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.

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