How do I resolve a CO-16+MA27 denial?

Verify patient entitlement number and name with the patient or payer eligibility system: Ensure the entitlement number (e.g., Medicaid ID, Medicare number) matches exactly what the payer has on file, including spelling and formatting Update claim with correct entitlement number and patient name in the appropriate fields: Enter the validated entitlement identifier and name exactly as they appear in payer records to prevent future mismatches Submit as a corrected claim with frequency code 7 and reference the original claim number: The corrected claim will replace the original submission and allow the payer to process with accurate entitlement information

835 Denial Combination

CO-16+MA27

Contractual Obligation · Claim-Level Adjustment

Missing Information

What This Combination Means

The payer rejected this claim due to a missing, incomplete, or invalid entitlement number or name field on the submission. This is a billing error where the patient identifier or entitlement information does not match payer records or was not provided correctly. The provider is contractually obligated to write off the adjustment and must correct the entitlement data before resubmitting.

Financial Responsibility

provider writeoff

The provider must write off this amount as a contractual adjustment because the claim contained a submission error. The patient cannot be billed for this amount.

N/A

Appeal Success

5-10 business days (corrected claim)

Avg. Resolution

Medium

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-16+MA27 combination — not generic advice.

Not Appealable:This is a submission error requiring corrected claim resubmission, not an appeal, as the entitlement information was missing or invalid on the original claim.

1
Verify patient entitlement number and name with the patient or payer eligibility system
Ensure the entitlement number (e.g., Medicaid ID, Medicare number) matches exactly what the payer has on file, including spelling and formatting
2
Update claim with correct entitlement number and patient name in the appropriate fields
Enter the validated entitlement identifier and name exactly as they appear in payer records to prevent future mismatches
3
Submit as a corrected claim with frequency code 7 and reference the original claim number
The corrected claim will replace the original submission and allow the payer to process with accurate entitlement information

Specialty Context

How CO-16+MA27 typically presents across different practice types.

Dental

Verify Medicaid or dental plan member ID matches exactly as shown on the patient's benefits card, including any alpha prefixes or suffixes

Medical

Common with Medicare Advantage plans where member ID differs from Medicare number, or Medicaid claims where the entitlement number format varies by state program

Behavioral Health

Frequently occurs when patients transition between Medicaid programs or when using incorrect member ID for managed behavioral health carve-out plans

Individual Code References

View the standalone definition for each code in this combination.

CARC 16 RARC MA27

Medicare Contractor Guidance for CARC 16

FCSO + Noridian + uhc + aetna + bcbs_az

This RUC is received when a claim is submitted with missing, incorrect, or invalid information. For details pertaining to your claim, please refer to the remittance advice remark codes (RARCs) on the remittance advice (RA).

How to Prevent CARC 16 Denials

✓
Review the RARC on the remittance advice to identify which specific field has the error.
✓
Per Medicare guidelines, claims must be filed no later than 12 months after the date of service. RUCs are not considered filed/submitted.

CMS guidelines for completion of form CMS-1500 in the Medicare Claims Processing Manual (100-04), Chapter 26SPOTFee Schedule Lookup ToolCMS laboratory demographics lookupModifier lookup toolNoridian Medicare PortalNMPIVRSame or SimilarPECOSPDAC

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Synthesized from official definitions — not from training data

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