Which term indicates why a payer did not pay an amount on a claim?

Master the EPIC Resolute Hospital Billing Test. Prepare with detailed flashcards and multiple-choice questions, each with helpful hints and comprehensive explanations. Ace your exam!

Multiple Choice

Which term indicates why a payer did not pay an amount on a claim?

Reason codes explain why a payer did not pay an amount on a claim. They provide the specific denial or reduction reason attached to a line item—things like not covered, missing information, time-based filing limits, or services not medically necessary—so you know exactly what action is needed (appeal, resubmit, or correct information). In Resolute and typical payer postings, this code is the primary way the system communicates the payer’s rationale for nonpayment or partial payment. Follow-Up Record is used to track actions on claims, not to convey the payer’s denial reason; Paid Amount is the actual amount paid, and Billed Amount is the amount charged.

Reason codes explain why a payer did not pay an amount on a claim. They provide the specific denial or reduction reason attached to a line item—things like not covered, missing information, time-based filing limits, or services not medically necessary—so you know exactly what action is needed (appeal, resubmit, or correct information). In Resolute and typical payer postings, this code is the primary way the system communicates the payer’s rationale for nonpayment or partial payment. Follow-Up Record is used to track actions on claims, not to convey the payer’s denial reason; Paid Amount is the actual amount paid, and Billed Amount is the amount charged.

More practice questions