835 Denial Combination
CO-16+N264
Contractual Obligation · Claim-Level Adjustment
Missing InformationWhat This Combination Means
The claim was denied due to missing, incomplete, or invalid ordering provider name information. This is a contractual adjustment resulting from a billing error where the required ordering provider identification was not properly submitted or was incomplete. The payer cannot process the claim without valid ordering provider details as required by regulatory and contractual standards.
Financial Responsibility
provider writeoff
The provider must write off the denied amount per contractual obligation with the payer. The patient cannot be billed for this adjustment because it results from the provider's billing error.
N/A
Appeal Success
7-14 days (corrected claim reprocessing)
Avg. Resolution
Medium
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-16+N264 combination — not generic advice.
- 1
Verify ordering provider NPI and name in practice management system
Ensure ordering provider information matches NPPES registry exactly, including proper credentials and spelling
- 2
Update claim with complete ordering provider information in Loop 2310A
Include ordering provider NPI in REF segment and full name in NM1 segment per X12 837 requirements
- 3
Submit corrected claim with Claim Frequency Code 7
File as replacement claim to correct the ordering provider information and obtain proper adjudication
Specialty Context
How CO-16+N264 typically presents across different practice types.
Dental
Medical
Common for diagnostic imaging, laboratory services, durable medical equipment, and home health claims where an ordering provider separate from the rendering/billing provider is required by Medicare and commercial payers
Behavioral Health
May occur on outpatient therapy or psychiatric claims when services require a physician order but the ordering psychiatrist or physician NPI/name is missing or incomplete
Individual Code References
View the standalone definition for each code in this combination.
Medicare Contractor Guidance for CARC 16
FCSO + Noridian + uhc + aetna + bcbs_azThis 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.
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