Insurance will deny the claim with denial reason code CO 16 accompanied with remarks code, whenever claims submitted with missing, invalid or incorrect information.
Denial reason code CO 16 states Claim/Service lacks information which is needed for adjudication and it will be accompanied with remarks codes, which indicates the exact missing information in order to adjudicate the claims.
Below are the few Examples:
Remarks Code or MOA Code
|CO 16||MA27 (Missing /incomplete/invalid entitlement number or name shown on the claim)|
|CO 16||N245 (Incomplete/invalid plan information for other insurance)|
|CO 16||MA112 (Missing /incomplete/invalid group practice information)|
|CO 16||N286 (Missing /incomplete/invalid referring provider primary identifier)|
|CO 16||M77 (Missing /incomplete/invalid Place of Service)|
|CO 16||MA112 (Missing /incomplete/invalid CLIA Certification number)|
The information requested from the Insurance Company is not specific, as it may vary on each claim.
Below is the list of remark codes we frequently come across, when claims get denied as
CO 16 – Claim/Service lacks information which is needed for adjudication:
|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)||This remark codes are related to Beneficiary Name, SSN or HICN or Medicare Number. So review the Member card on file, check eligibility and enter the correct information as indicated on the claim form.|
|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||These codes are related to Billing entity/provider. Refer the Field 33 and 33A on the HCFA form. Enter the correct billing provider/supplier name, address, zip code and telephone number in field 33 and billing provider/group NPI in field 33A.|
|M79||Missing/incomplete/invalid charges on claim||This remark code is related to Charges on claim. Refer to field 24F on the claim form. Enter the charges for all the service listed on the Claim form.|
|MA120||Missing/incomplete/invalid CLIA-Clinical Laboratory Improvement and Amendment Certification number||Please refer a field 23 and enter a valid CLIA Certification number.|
|M52 and N345||Missing/incomplete/invalid Date of Service and Date range not valid with units submitted||Please refer a field 24A and 24G on the claim form and enter valid information.|
|M76 and M81||Missing/incomplete/invalid diagnosis or condition or you are required to code to the highest level of specificity.||Please refer a field 21 on the claim form and enter the appropriate ICD indicator and DX code.|
|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 refer the field 17 and 17 B on the HCFA form and enter the correct information|
|M51||Missing/incomplete/invalid procedure code||Refer the field 24D and enter the correct procedure code|
|N290 and MA112||Missing/incomplete/invalid rendering provider primary identifier and group practice information||Please refer the field 24J on the claim form and enter the valid individual provider NPI.|
Please refer field 33 on the claim form and enter the correct billing group name, address, zip code and telephone number.
So whenever you get CO 16 – Claim/Service lacks information which is needed for adjudication, the first thing is to check the remarks code to find out the missing information.
If you are finding it difficult to find out what exactly the insurance company is requesting to adjudicate the claim, then the best way is to call that particular insurance company claims department to find out the exact information they are requesting in order to process the claims towards payment.
Below is the list of information needs to be collected when you reach the claims department for above denial Code CO 16 – Claim/Service lacks information which is needed for adjudication.
|1||May I know when you have received the Claim (Claim received date)|
|2||May I know when the claim was denied (Claim Denied date)|
|3||May I know what exact information is required in order to adjudicate the claim towards payments|
|4||May I know whether the required information is needed from Patient/Provider|
|5||May I know whether any Letter/EOB sent to Patient/Provider|
|6||If Yes||If No|
|7||May I know the date when the letter was sent to Patient/Provider||Could you please send a Letter/EOB to Patient/Provider|
|8||Have you received any response from the patient/provider|
|9||If Yes||If No|
|10||Could you please send this claim back for reprocessing||Could you please send one more Letter/EOB to Patient/Provider|
|11||May I know the claim number|
|12||May I know the call reference number|