CO-16 Claim lacks information missing denial in Medical Billing Services

Medical billing services


When claims are submitted with missing, invalid, or erroneous information, insurance will deny the claim with denial reason code CO-16. Denied code reason CO-16 specifies that a claim or service lacks information that is necessary for adjudication, and it will be accompanied by comments codes that specify the precise information that is missing from the claim or service in order to make an adjudication.

 

Some Reason codes for Claim/Service lacks information which is needed for adjudication:

Remarks Code or MOA Code

MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is un-process able. Please submit a new claim with the complete/accurate details.

MA27: Incomplete/missing /invalid entitlement number or name shown on the claim.

N382: Missing/incomplete/invalid patient identifier.

N286: Missing /incomplete/invalid referring provider primary identifier.

N245: Incomplete/invalid plan information for other insurance.

As a result, the first thing you should do anytime you receive a CO 16 - Claim/Service lacks information that is needed for adjudication, is to verify the remarks code to identify the missing information.


Important Steps you should know about Claim/service lacks information missing denials:

·        Look up the claim remarks codes in the received EOB.

·        Recheck the claim/HCFA-1500 form for missing information

·        Verify the patient eligibility with the available information

·        In case of any mismatch of the patient information (request the concern person for that information).

·        After following all the above-mentioned steps; if you feel there is gab somewhere to find out the correct reason of the denial, you can follow the below steps to call the insurance and confirm the missing information box in the HCFA -1500 form.


ü Denial claim number

ü Denial claim date

ü Missing information for the denial claim or specific box where information is missing for the claim.

ü Request the EOB (in case of missing EOB)

 

Conclusion:

The easiest option is to call the claims department of that particular insurance company to find out the precise information they are requesting in order to process the claims towards payment if you are having trouble understanding what the insurance company is asking for to adjudicate the claim. Streamline your healthcare Medical Billing Services with our expert support and experience to ensure accuracy, efficiency, and maximum revenue recovery.

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