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Delay Reason Code

A delay reason code tells the payer why a claim was sent after the filing limit. It does not promise payment, but a late Medicaid claim without one is almost always denied.

Definition

A delay reason code is a short code on an electronic claim that tells the payer why the claim was sent after the filing limit. It is X12 data element 1514, and it goes in CLM20 of loop 2300 on the 837P (professional) and 837I (institutional) claim.

Medicaid programs use delay reason codes the most. A late claim with a valid code and proof is usually given extra time. A late claim without one is usually denied for timely filing (CO-29).

All Delay Reason Codes

Code	Official name	Plain English
1	Proof of eligibility unknown or unavailable	The patient did not tell you about their coverage
2	Litigation	A lawsuit or hearing had to decide who pays
3	Authorization delays	The payer or state delayed the claim, such as a late rate update
4	Delay in certifying provider	Your enrollment with the payer was approved late
5	Delay in supplying billing forms	The payer was late sending required forms
6	Delay in delivery of custom-made appliances	A custom device was delivered long after it was ordered
7	Third party processing delay	Medicare or another insurer was slow to process first
8	Delay in eligibility determination	Coverage was approved or backdated after the visit
9	Original claim rejected or denied for a reason unrelated to the billing limit	You are resubmitting a claim first sent on time
10	Administration delay in the prior approval process	Approval came late because of an appeal or hearing
11	Other	A reason not listed; many payers limit how it can be used
15	Natural disaster	A declared disaster stopped you from billing

The X12 list also includes code 16 (lack of information) and code 17 (no response to initial request). Few payers use them on claims.

Where the Code Goes

837P or 837I: CLM20, in loop 2300 (claim information).
CMS-1500 paper claim: there is no box just for it. Payers that accept late paper claims give their own instructions. See our CMS-1500 box-by-box guide.
Proof: keep what shows when the delay ended, such as the eligibility notice, the primary payer's EOB or the enrollment approval letter.

A Real Example: New York Medicaid

State rules decide how much extra time a code buys. New York Medicaid's Guide to Timely Billing shows how one state does it:

Rule	New York Medicaid
Normal filing limit	90 days from the date of service
With a valid delay reason	Usually 30 days from the date the delay ended
Code 1 (eligibility unknown)	Submit within 30 days of learning about the coverage
Code 8 (eligibility determination)	Submit within 30 days of the eligibility notice
Code 9 (resubmission)	Resubmit within 60 days of the remittance; not allowed after a timely filing denial
Code 6 (custom appliances)	Not accepted
Final limit	2 years from the date of service

Other states have their own windows, so check your state Medicaid billing manual before you rely on a code.

Which Code Fits? Common Cases

What happened	Code
The patient said they had no insurance, then you learned they had Medicaid	1
Medicaid was approved after the visit and backdated to cover it	8
Medicare or the primary insurer took months to pay, so the Medicaid claim is late	7
Your first claim was on time but denied for a coding error, and you are resubmitting	9
Your provider enrollment was approved after you saw the patient	4
A declared disaster closed your office	15

Common Mistakes

Using code 11 (other) as a catch-all. Many payers limit it to specific cases.
Using code 9 after the claim has already denied for timely filing.
Sending the code without proof of when the delay ended.
Expecting commercial payers to honor the code. Most have their own late claim or reconsideration rules.
Missing the short window after the delay ends. The extra time is often only 30 days.

Check any payer deadline with our timely filing calculator, and read our timely filing limits guide.

Sources: X12 element 1514, Delay Reason Code; New York State Medicaid (eMedNY), Guide to Timely Billing; 42 CFR 424.44 (Medicare time limits and exceptions).

Frequently Asked Questions

What is a delay reason code?

A delay reason code is a code on an electronic claim that tells the payer why the claim was sent late. It goes in the CLM20 element of loop 2300 in the 837 claim. Medicaid programs use these codes most.

What is delay reason code 8?

Code 8 means delay in eligibility determination. Use it when the patient's coverage was approved or backdated after the date of service, such as a retroactive Medicaid approval.

What is delay reason code 9 used for?

Code 9 means the original claim was rejected or denied for a reason that had nothing to do with the filing limit. Use it when you resubmit a claim that was first sent on time. Some states, such as New York, do not allow it once a claim has denied for timely filing.

Where does the delay reason code go on a claim?

On an electronic 837P or 837I claim, it goes in CLM20 in loop 2300. The CMS-1500 paper form has no box just for it, so follow your payer's instructions for paper claims.

Do delay reason codes work for Medicare?

Original Medicare handles late claims through its own short list of exceptions, such as a Medicare error or retroactive Medicare entitlement. A delay reason code alone will not get a late Medicare claim paid. Follow your Medicare contractor's process.

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Reviewed by Hassan Raza Awan, Founder — 4+ years of hands-on U.S. medical billing experience. General billing information — verify against current CMS guidance and your payer contracts.

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