Reason Code 5OP69: Service Is Subject to Prior Authorization and No UTN Is Present on the Claim

Published 07/23/2021

Reason code 5OP69 indicates that the service is subject to prior authorization and no UTN is present on the claim. The program indicator and item or service do not match an occurrence on the prior authorization auxiliary file.

Reason for Denial
No UTN was present on the claim, the service billed on the claim did not match the occurrence on the prior authorization form.

How to Avoid This Denial

  • Submit the prior authorization form for one of the five hospital outpatient department pre-authorization services prior to submitting your claim for payment
  • Be sure to include the assigned UTN
  • Verify that the service billed matches the service on the prior authorization form