How does Counterclaim generate an insurance appeal letter?

Counterclaim uses a 5-agent AI pipeline. The Reader extracts claim data from your document. The Researcher identifies applicable state insurance law. The Writer drafts a formal appeal letter. The Adversary identifies weaknesses. The Editor rewrites the letter to eliminate all weaknesses. The final letter is ready to print and mail in minutes.

Is Counterclaim free to use?

Yes - Counterclaim is free during the launch period. Upload your denial letter and receive a complete adversary-tested appeal letter at no cost. No account required.

What types of insurance denials can Counterclaim handle?

Counterclaim handles all major denial types: medical necessity (CO-50), prior authorization (CO-11), experimental treatment (PR-1), fee schedule (CO-45), timely filing (PR-27), not covered (CO-4), step therapy (PR-50), and missing information (CO-16).

What file formats does Counterclaim accept?

Counterclaim accepts PDF files, JPG and PNG photos, and scanned documents of your denial letter or Explanation of Benefits (EOB).

Does Counterclaim provide legal advice?

No. Counterclaim generates appeal letters based on publicly available legal and clinical information but does not constitute legal advice. For complex cases, consult a licensed healthcare attorney or certified patient advocate.

What does CO-96 mean on my insurance claim?

CO-96 means 'non-covered charge(s).' It signals that the insurer is not paying because it considers the charge outside your benefits, but the code alone does not say why. The specific reason is provided in an accompanying Remittance Advice Remark Code (RARC). Always read the remark code next to CO-96 to learn the actual basis for the denial.

How do I find the real reason behind a CO-96 denial?

Look on the remittance advice or Explanation of Benefits for a remark code printed near CO-96, these are alphanumeric codes such as N130, N386, or M-series codes. That remark code states the precise reason (for example, a plan exclusion, a missing document, or a coding issue). If you cannot locate or interpret it, call the insurer and ask them to identify the remark code and explain what it requires.

Is a CO-96 denial the same as a CO-204 not-covered denial?

They overlap but are not identical. CO-204 specifically asserts that a service, equipment, or drug is not covered under your current benefit plan. CO-96 is a broader non-covered catch-all that can stand in for many reasons, including exclusions, bundling, or documentation gaps, with the exact reason carried in the accompanying remark code. With CO-96, decoding the remark code is the essential first step.

Can a CO-96 non-covered denial be appealed?

Yes. Once you decode the remark code, request the exact plan language the insurer is relying on. Many apparent exclusions are overridden by state mandated benefit laws or federal mandates such as the ACA's essential health benefits and preventive coverage requirements or the Mental Health Parity Act. If the remark code points to a coding or documentation issue, ask your provider to correct and resubmit, which often resolves it without a formal appeal.

What if the insurer will not tell me the remark code?

Insurers are required to provide a clear explanation of why a claim was denied. If member services cannot explain the remark code, submit a written request for the full claim adjudication detail and the specific plan provision being applied. Keep a record of every call. If they continue to refuse, that itself is grounds for a complaint to your state department of insurance.

CO-96

How to Decode and Appeal a CO-96 Non-Covered Charge Denial

Got a vague CO-96 non-covered charge denial? The real reason hides in the remark code printed next to it. Learn how to find the RARC, decode the true reason, and appeal.

What does CO-96 mean?

A CO-96 denial means the insurer is calling the charge 'non-covered,' but CO-96 by itself is deliberately uninformative. It is a generic catch-all code that is almost always accompanied by a Remittance Advice Remark Code (RARC), a separate alphanumeric code printed next to CO-96, that states the actual reason. Your first job with a CO-96 denial is to find that remark code, because it tells you what you are really appealing.

Why insurers issue CO-96 denials

Insurers use CO-96 as a container for many different non-coverage decisions: a service excluded by the plan, a missing modifier, a service the plan considers bundled, a benefit the plan claims is not a covered item, or a documentation gap. Because the code is generic, the insurer is required to pair it with one or more remark codes (RARCs) that specify the precise reason. Patients and even billing staff often stop at 'non-covered' without reading the remark code, which is exactly where the appealable detail lives.

Appeal strategy

Find the Remittance Advice Remark Code (RARC) printed alongside CO-96 on the remittance advice or Explanation of Benefits, it is the actual reason. If you cannot find it, call the insurer's provider or member line and ask them to read you the remark code and explain it. Once you know the real reason, appeal on that basis: request the specific plan exclusion language, check it against your state's mandated benefit laws and federal mandates (ACA essential health benefits, MHPAEA parity, ACA preventive coverage), and ask your provider to correct any coding error the remark code identifies.

Frequently asked questions about CO-96

CO-50

Medical Necessity Denial (CO-50)

CO-11

Prior Authorization Denial (CO-11)

CO-55

Experimental Treatment Denial (CO-55)

CO-45

Exceeds Fee Schedule Denial (CO-45)