Working Down Denials
CO16: Claim/service lacks information which is needed for adjudication
Claim/service lacks information which is needed for
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 firstname.lastname@example.org.