Denial Codes and Solutions

Denial Code CO 16

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Denial Code CO 16 – Claim/service lacks information or has submission/billing error(s) which is needed for adjudication

It means insurance company deny the claim or service with denial code CO 16, when insurance company cannot adjudicate the claim due to incomplete information or has errors in submission or billing.

In order identify the exact missing information or invalid information or incorrect information, insurance will deny the claim with denial code CO 16 along with the remarks code. So here remark code clearly indicates the exact information missing or errors in submission or billing.

Denial Code CO 16 along with remark codes:

When claim denied with the following remark codes, please take up the following action to resolve the claim:

  1. MA27, MA36, MA61 and N382 – Missing/incomplete/invalid Patient Name, Social Security Number, entitlement number or name shown on the claim or patient identifier (HICN or MBI)

Here remark codes indicate its related to Beneficiary Name, Social Security Number or HICN or Medicare Number. In this case review the insurance card on file, check eligibility and enter the correct details of Beneficiary Name, Social Security Number or HICN or Medicare Number.

  • N256, N257, N258 and MA112 – Missing/incomplete/invalid Billing provider/Supplier name, Billing provider/supplier primary identifier, Billing provider/supplier address and group practice information

It’s related to Billing entity/provider. So kindly check the block number 33 and 33A on the HCFA form and submit the correct billing provider/supplier name, address, zip code and telephone number on block number 33 and billing provider/group NPI on block number 33A.

  • M79 – Missing/incomplete/invalid charges on claim

Remark code M79 is related to charges on claim, so here kindly check the block number 24F on the claim form and enter the charges for all the service listed on the Claim form.

  • MA120 – Missing/incomplete/invalid CLIA-Clinical Laboratory Improvement and Amendment Certification number

Check block number 23 and enter a valid CLIA-Clinical Laboratory Improvement and Amendment Certification number.

  • M52 and N345 – Missing/incomplete/invalid Date of Service and Date range not valid with units submitted

Please verify block number 24A and 24G on the claim form and enter valid Date of Service and units.

  • M76 and M81 – Missing/incomplete/invalid diagnosis or condition or you are required to code to the highest level of specificity.

Check block number 21 on the claim form and enter the appropriate diagnosis code with proper indicator.

  • N264, N265, N276, N285 and N286 – Missing/incomplete/invalid ordering provider name, ordering provider primary identifier, other payer provider identifier, referring provider name and referring provider primary identifier.

Please Check the block number 17 and 17 B on the claim form and enter the valid provider information

  • M51– Missing/incomplete/invalid procedure code

Kindly check the block number 24D and enter the correct CPT code

  • N519 – Invalid combination of HCPCS modifiers
  • N823 – Incomplete/invalid modifiers
  • M77 – Missing /incomplete/invalid Place of Service
  • N34 – Incorrect claim form/format for this service.
  • M44 – Missing/incomplete/invalid condition code
  • MA43 – Missing/incomplete/invalid patient status
  • M50 – Missing/incomplete/invalid revenue codes
  • M20 – Missing/incomplete/invalid HCPCS
  • M64 – Missing/incomplete/invalid other diagnosis
  • MA65 – Missing/incomplete/invalid admitting diagnosis
  • M67 – Missing/incomplete/invalid other procedure codes
  • MA63 – Missing/incomplete/invalid principal diagnosis
  • MA39 – Missing/incomplete/invalid gender
  • N382 – Missing/incomplete/invalid patient identifier
  • N329 – Missing/incomplete/invalid patient birth date
  • N77 – Missing/incomplete/invalid designated provider number
  • M45 – Missing/incomplete/invalid occurrence codes
  • M46 – Missing/incomplete/invalid occurrence span codes
  • MA41 – Missing/incomplete/invalid admission type
  • MA30 – Missing/incomplete/invalid type of bill
  • N345 – Date range not valid with units submitted
  • N822 – Missing procedure modifiers

And so on……

Whenever claim denied with denial code co 16, the very first step is to check the remark codes it accompanied with and take necessary action based on the remark codes.

If you are unable to identify the remark codes, then it’s better to reach the insurance company claims department to find the exact information lacking for adjudicating the claim.

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)