How the CBHPM code is structured

Denial code 1714 is one of the most frequent refusals in hospital billing. It occurs when the amount charged for a service is higher than the amount set in the payer’s reference table, leading to full or partial rejection of the charge. For hospitals with a high volume of claims, this denial code means recurring revenue loss, audit rework and pressure on cash flow.

According to the Anahp Observatory 2025, the accepted denial rate at mid-sized and large hospitals reached 1.96% of gross revenue from health plans in 2024, up from 0.78% in 2021. Denials due to price discrepancies, such as code 1714, are among the main causes of this growth and, at the same time, among the most avoidable with the right processes.

This article presents the concept of denial code 1714, its most common causes, what to check before filing an appeal and the best practices to prevent it.

What is denial code 1714?

Denial code 1714 is the code health plans use to signal that the amount charged by the provider (hospital, clinic or laboratory) exceeds the limit set in the contract table. The rejection can be full, when the entire amount is above the limit, or partial, when the payer pays the contractual maximum and denies the excess.

This type of denial is directly tied to the application of tables such as TUSS (Unified Terminology for Supplementary Health), CBHPM (Brazilian Hierarchical Classification of Medical Procedures), AMB or other references defined in the contract.

Any discrepancy between the amount billed and the ceiling of these tables opens the door to denial code 1714. For a broader view of the types of denials, see Claim denials: what they are and how to prevent them.

Main errors that lead to denial code 1714

In practice, denial code 1714 usually originates in inconsistencies that can be identified before the claim is submitted. The table below summarizes the most common causes, how each one shows up and the corresponding preventive action:

Can denial code 1714 be the payer’s error?

Yes. The source of the denial is not always the provider. In some cases, the payer issues the refusal for reasons that have nothing to do with hospital billing:

• Tables with outdated amounts in the payer’s system, still reflecting earlier adjustments that were not incorporated.

• Contract adjustments approved by the provider but not yet processed in the payer’s system.

• Contract changes made by the payer without formal notice to the provider, creating a discrepancy between the table used for billing and the table in force for payment.

In these cases, the denial is considered unwarranted. A careful analysis of its origin is the essential step before any internal corrective action or appeal.

The risk of linear denials

One point to watch is the use of linear denials: automatic, across-the-board reductions in amounts by the payer, with no individual analysis of each claim. When this happens, correct claims are denied along with those that actually have a discrepancy, causing financial losses that go unnoticed without active monitoring.

Identifying linear patterns requires cross-checking data across the denied claims: if the reduction applied is proportional and uniform across claims of different kinds, the pattern suggests a linear denial. In that situation, the administrative appeal should be filed on contractual and documentary grounds, disputing the practice as a whole.

What to do when you receive denial code 1714?

When you identify denial code 1714 on a payment statement, the analysis should follow this sequence:

1. Compare the amount billed with the contract table in force.Go to the contract with the payer and check whether the amount charged was within the allowed limit on the date of service.

2. Identify the nature of the discrepancy.Is the discrepancy in the code, the amount, the multiplier or the reference table? Each cause calls for a different approach in the correction or the appeal.

3. Check for signs of a linear denial.See whether the reduction pattern repeats across multiple claims from the same payer, with a uniform percentage, which would indicate automatic application.

4. Confirm whether there was an internal operational error.If the source is in billing, fix the process before filing an appeal. Appealing your own error weakens the relationship with the payer.

5. Contact the payer if there is doubt about the table in force.When there is a difference in contract interpretation, direct contact can resolve it without the need for a formal appeal.

How to prevent denial code 1714 in hospital billing

Preventing denial code 1714 is a matter of governance over billing, not just occasional claim review. The actions with the greatest impact are:

• Systematic table updates in the systems:every reference table adjustment (Brasíndice, SIMPRO, CBHPM, AMB) must be incorporated into the billing system before any claim is submitted.

• Automatic validation of amounts before submission:tools that cross-check billed amounts against each payer’s contractual ceilings in real time eliminate most code 1714 denials before they happen.

• Formalizing exceptions in the contract:any charge outside the standard table, such as special fees or specific materials, must be covered by a contract clause or a signed amendment.

• Ongoing training of the billing team:contract rules change. The team needs to know each payer’s specifics, especially in higher‑volume contracts.

• Monitoring indicators by payer:tracking the code 1714 denial rate by payer makes it possible to identify recurring patterns and negotiate contract corrections when the problem originates in the payer’s system.

How to appeal denial code 1714

When the analysis confirms that the denial is unwarranted, that is, the amount billed was within the contractual limit, the appeal should be built on technical and documentary grounds:

• Supporting documentation: the contract in force with the payer, the reference table applicable on the date of service, a statement of the amount billed and the medical record or procedure report.

• Contractual grounds: cite the contract clause or annex that supports the amount charged. Appeals without a contractual anchor have a low reversal rate.

• Filing on time:each payer sets a deadline for submitting appeals. Missing it rules out the dispute, regardless of its merit.

• Active follow-up: appeals without follow-up tend to lapse. Record the response deadlines and escalate internally when there is no reply.

For a complete guide to the appeal process, see Denial appeals: how to control and recover amounts.

Denial code 1714 can be avoided with the right processes and technology

Denial code 1714 is usually a sign of misalignment between billing and each payer’s contract rules. Outdated tables, incorrect multipliers and unformalized exceptions account for most cases. With validated processes and pre-submission audit technology, this type of denial stops being a recurring occurrence.

Rivio’s AI platform automates hospital auditing and billing: it identifies price discrepancies before submission, cross-checks clinical data against each payer’s contract rules and manages denial appeals automatically.

By contract, Rivio commits to reimbursing the hospital 100% in cases where the denial is not reversed.

FAQ: frequently asked questions about denial code 1714

What does denial code 1714 mean?

Denial code 1714 is the payment refusal code health plans use when the amount charged by the provider exceeds the ceiling set in the contract table. The rejection can be full or partial, depending on the size of the discrepancy.

What are the main causes of denial code 1714?

The most frequent causes are: an amount charged above the contract table, an adjustment applied without the payer’s approval, use of a TUSS code of higher value than the procedure performed, charging for materials outside the reference table set in the contract and incorrect multipliers (surgical tier or quantity).

Does denial code 1714 always indicate a hospital error?

No. In some cases, the denial results from failures in the payer’s system, such as outdated tables or approved adjustments that have not yet been incorporated into processing. Before correcting any internal process, you need to identify the real source of the discrepancy.

What is a linear denial and how does it relate to denial code 1714?

A linear denial is an automatic, across-the-board reduction in amounts applied by the payer, with no individual analysis of each claim. It can generate code 1714 denials on correct claims, a contractually questionable practice. Identifying the linear pattern is essential to building an effective appeal.

How can denial code 1714 be avoided?

The main actions are: keeping the reference tables up to date in the systems, validating billed amounts against contractual ceilings before submission, formalizing any exception to the standard table in the contract and monitoring the denial rate by payer to identify recurring patterns.