How do I resolve a CO-16+N593 denial?

Verify IME appointment details and patient non-attendance: Confirm with scheduling records that an IME was scheduled and the patient did not attend the appointment as required by the payer. Document the denial reason in patient account: Note that services were rendered without completion of the mandatory IME prerequisite, making them non-covered under contract terms. Process contractual write-off: Apply the adjustment as a contractual write-off per the CO group code requirement; ensure patient is not billed for this amount.

835 Denial Combination

CO-16+N593

Contractual Obligation · Claim-Level Adjustment

Missing Information

What This Combination Means

The claim was denied due to missing information or a billing error specifically related to the patient's failure to attend a scheduled Independent Medical Exam (IME). The payer has identified that the service cannot be covered because the required IME prerequisite was not completed. This represents a contractual adjustment that the provider must absorb and cannot pass to the patient.

Financial Responsibility

provider writeoff

The provider must write off this amount per contractual obligation with the payer. The patient cannot be billed for services denied due to non-attendance at a required IME.

N/A

Appeal Success

Immediate (write-off)

Avg. Resolution

Easy

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-16+N593 combination — not generic advice.

Not Appealable:This is a contractual obligation adjustment based on the patient's failure to meet a payer requirement (attending the IME), not a payer error in claim processing.

1
Verify IME appointment details and patient non-attendance
Confirm with scheduling records that an IME was scheduled and the patient did not attend the appointment as required by the payer.
2
Document the denial reason in patient account
Note that services were rendered without completion of the mandatory IME prerequisite, making them non-covered under contract terms.
3
Process contractual write-off
Apply the adjustment as a contractual write-off per the CO group code requirement; ensure patient is not billed for this amount.

Specialty Context

How CO-16+N593 typically presents across different practice types.

Dental

Medical

Common in workers' compensation, auto injury, disability, and other cases where payers require Independent Medical Exams to establish medical necessity or continued need for treatment before authorizing services.

Behavioral Health

May occur in disability evaluations or long-term treatment authorization scenarios where payers require independent psychiatric or psychological evaluations before approving ongoing behavioral health services.

Individual Code References

View the standalone definition for each code in this combination.

CARC 16 RARC N593

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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