What a claim denial code means
denial_code_lookupWhat an insurance or Medicare denial code on an explanation of benefits means: a Claim Adjustment Reason Code (e.g. CO-97, PR-1, 197) or a Remark Code (e.g. M15, N432), from the X12 code lists. With a prefix it says whether the person may owe the amount (CO is the provider's write-off, PR is patient responsibility); for common codes it gives the typical fix and who acts. Not legal or billing advice.
Tool call template
Replace each placeholder with a value matching the input schema. Only required parameters are included; add optional parameters as needed.
{
"id": 1,
"jsonrpc": "2.0",
"method": "tools/call",
"params": {
"arguments": {
"code": "<code>"
},
"name": "denial_code_lookup"
}
}Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| code | Yes | The code as printed, e.g. CO-97, PR-204, 50 or N432. |