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Missing/Incorrect Required Claim Information - JF Part B

Missing/Incorrect Required Claim Information

CARC/RARC Description
CO-16 Claim/service lacks information or has submission/billing error(s) which is needed for adjudication.
M51 Missing/incomplete/invalid procedure code(s).
N56 Procedure code billed is not correct/valid for the services billed or date of service billed.


Common Reasons for Message

  • Information required for claim processing is either missing or incorrect

Next Step

  • Submit new claim with corrected/complete information
    • Claim is unprocessable; no appeal rights

Claim Submission Tips

  • Ensure procedure code is appropriate and valid for services billed and dates of service
  • Select CPT or HCPCS code that accurately identifies service or procedure performed
  • If no such code exists, use appropriate unlisted procedure code
    • Enter a brief yet complete description of services rendered in Item 19 of CMS-1500 claim form or SV101-7 field for Electronic Media Claims (EMC)
    • If characters extend beyond SV101-7, continue entering in Loop 2300 NTE Segment
    • For an unclassified drug code, enter drug name and dosage in Item 19 on CMS-1500 claim form or electronic equivalent
    • Enter one (1) unit in Item 24G
  • Procedure codes that require pricing per invoice must contain invoice price plus shipping cost (do not include handling or other fees). View Avoiding Denials on Priced Per Invoice Claims


Last Updated Mon, 21 Nov 2022 16:14:06 +0000