1) Expenses incurred after the patient's plan terminated. a) Provider not eligible b) Patient not eligible 2) The required modifier is missing or inappropriate with the procedure code. a) Coding issue b) Demographic issue 3) Subscriber exceeded the number of visits. a) Coverage termed b) Benefit limit reached 4) Need additional info to process the claim. a) Need medical records b) Need EOB 5) Provider's NPI is incorrect. a) W9 form b) Need Tax ID 6) Claim paid to patient. a) COB not signed b) AOB not signed 7) Services not covered under the patient's plan. a) Patient not eligible b) Non-covered 8) This service is already paid previously. a) Need Appeal b) Duplicate claim 9) Claim denied due to lack of prior authorization a) No authorization b) Retro authorization 10) Claim applied towards patient's responsibility. a) Capitation b) Deductible

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