For a rejected claim, which element on the EOB/RA should be reviewed?

• A. The reason code and legend provided for the rejection.
• B. The patient’s date of birth.
• C. The hospital location.
• D. The provider's license number.

Answer: (A)

When a claim is rejected, the item to review on the Explanation of Benefits or Remittance Advice is the reason code and its legend. The reason code tells you why payment was denied, and the legend provides a plain-language description of that code. Together, they point you to the exact issue to fix or the documentation needed to support a correction or appeal, such as missing information, non-covered services, or inadequate medical necessity documentation. Other fields like the patient’s date of birth, the hospital location, or the provider’s license number are for identification or verification and do not explain the denial. Focusing on the reason code and legend gives you the actionable insight to resolve the rejection.