835 Denial Combination

CO-16+N245

CO

Contractual Obligation · Claim-Level Adjustment

Missing Information

What This Combination Means

The claim was denied due to missing or invalid coordination of benefits (COB) information regarding other insurance coverage. The payer requires complete and accurate details about the patient's other insurance plan to process the claim correctly. This is a submission error related to COB data quality.

Financial Responsibility

provider writeoff

The provider must write off the denied amount per contractual obligation. The patient cannot be billed for this adjustment resulting from incomplete COB submission data.

N/A

Appeal Success

7-14 days (corrected claim)

Avg. Resolution

Medium

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-16+N245 combination — not generic advice.

Not Appealable:This is a correctable submission error requiring resubmission with complete other insurance information, not an appeal of a coverage determination.
  1. 1

    Contact patient to obtain complete other insurance information

    Verify current coverage status, policy/group numbers, subscriber name and relationship, and effective dates for all other insurance plans

  2. 2

    Update patient demographics and insurance information in practice management system

    Enter complete COB details including payer name, policy identification, and coordination sequence to ensure accurate claim submission

  3. 3

    Resubmit claim as corrected with complete COB information in appropriate loops

    Include all required other insurance data in loop 2320 and 2330 segments to meet payer COB requirements

Specialty Context

How CO-16+N245 typically presents across different practice types.

Dental

Common when patients have dual dental coverage (e.g., through own employer and spouse's plan) and incomplete COB information prevents payer from determining payment responsibility

Medical

Frequently occurs with Medicare/commercial coordination, dual eligibility situations, or when dependent children have coverage through multiple parents; payers require complete Plan information in 2320A/B loops

Behavioral Health

Seen when patients transition between Medicaid and commercial coverage or have both EAP benefits and health plan coverage; accurate COB is critical for carve-out benefit coordination

Individual Code References

View the standalone definition for each code in this combination.

CARC 16RARC N245

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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