Working Down Denials

CO16: Claim/service lacks information which is needed for adjudication

CO16Claim/service lacks information which is needed for adjudication The CO16 denial code alerts you that there is information that is missing in order

CO16
Claim/service lacks information which is needed for
adjudication

The CO16 denial code alerts you that there is information that
is missing in order for Medicare to process the claim. Due to the
CO (Contractual Obligation) Group Code, the omitted information is
the responsibility of the provider and, therefore, the patient
cannot be billed for these claims.

Additional information regarding why the claim is denied may be
supplied by Medicare through remittance advice remarks codes. If
the additional remark codes are not provided, suppliers must call
Medicare and speak with a representative to get the information
needed to resubmit the claim.

Some reasons you may receive a CO16 denial include (but are not
limited to):

  • Billing for place of service 31 (Skilled Nursing Facility) and
    not listing the facility's address on the claim

  • Incorrect date span

  • Missing the LT (left) or RT (right) modifier

As you can see, these denials are easy to fix. Billers only need
to add or correct the appropriate information and resubmit the
claim to receive payment.

Based on analysis of 3,680,443 claims adjudicated by the
Medicare contractors between July 1, 2006, and Sept. 30, 2006, and
processed for RemitDATA customers. Source: RemitDATA,
866/885-2974,
www.remitdata.com.

Sarah Hanna is a reimbursement consultant and vice president of
ECS Billing & Consulting, Tiffin, Ohio, and specializes in
proper billing protocols, Medicare coverage guidelines and billing
office procedures. She can be contacted at 419/448-5332 or sarahhanna@bright.net.



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