Every phrase we decode

• Not medically necessary
• Experimental or investigational
• Prior authorization required or not obtained
• Not a covered benefit or plan exclusion
• Out of network
• Insufficient documentation or additional information needed
• Step therapy or fail-first
• Not covered for this diagnosis or indication
• Timely filing limit exceeded
• Level of care not appropriate (observation, inpatient, facility)
• Coverage terminated or not in effect on the date of service
• Duplicate claim