CO 16 Denial Code Description, Causes & Resolution

As a healthcare provider, you spend most of your time seeing and tending to patients. 

Charting patient symptoms, drawing diagnoses, and deciding on the best treatment plans while keeping the patient engaged are necessary to keep your MIPS score high. 

Already, keeping the billing and payment cycle optimized for faster reimbursements is a constant struggle. But denials make it impossible to achieve!

Thus, in this guide, we will discuss the denial code CO 16, its common causes, best practices to prevent it, and steps to resolve it. 

So, without delay, let’s get started!

CO 16 Denial Code – Description

You may receive the denial code CO 16 when there is missing or incorrect information in a medical claim. However, it is not used to indicate missing documents or attachments. 

Moreover, at least one remark code is provided to explain what happened to the claim, that is not an alert. It can be either the Remittance Advice Remark Code or the NCPDP Reject Reason Code.

Common Causes of CO 16 Denial Code 

Is the denial code CO 16 straining your practice from its rightful reimbursements? Are you unsure what you are doing wrong? Don’t worry! In this section, we will explore the common causes behind this denial to help you navigate it efficiently.

Missing Information

Missing information is the main culprit behind denial code CO 16. For example, the payer may flag this denial code if your submitted claim contains incomplete patient demographic information or if the diagnosis/ procedure codes/ modifiers are missing.

Errors in Billing or Submission

Another reason behind getting the denial code CO 16 is errors in billing or submission, such as inaccurate or mismatched diagnosis and procedure codes, inconsistent information, formatting errors, typos, and duplicate claims.

Outdated Provider Details

You may also receive this denial if your claim includes an inactive or outdated national provider identifier (NPI) and missing or incorrect place of service (PoS) details. Besides, the healthcare provider who rendered care services had credentialing issues.

Lack of Prior Authorization

Most of the payers require healthcare providers to obtain prior authorization before performing specific procedures or services. Thus, failure to obtain it may also result in this denial.

Preventive Strategies for Denial Code CO 16

We have already discussed the causes behind the CO 16 denial code. It is time to share some preventative strategies to reduce the likelihood of this denial:

Double-check Claim for Errors

You should review the information for inaccuracies and inconsistencies before submitting a claim to the insurance payer, such as provider details, patient demographics, and service information. It will help you address discrepancies that may result in denial code CO 16.

Utilize a Claim Scrubbing Software

Claim scrubbing tools have built-in checks to systematically identify missing details or errors in medical billing reports. Thus, implementing a robust claim scrubber should be your next preventive strategy to avoid CO 16 denial code. 

It will enable you to resolve issues related to missing modifiers, mismatched diagnosis and procedure codes, or inaccurate patient information before you submit a claim. 

Train Your Staff

You must also provide comprehensive training to your staff on the latest coding systems and guidelines. The reason? Well, when they are well-versed in the coding standards, they will make fewer errors and use appropriate modifiers, streamlining your billing workflow and leading to faster reimbursements.

Utilize Electronic Claim Submission

Electronic claims are less prone to mistakes and faster to process, significantly minimizing the chances of errors or missing details that may result in this denial code. Besides, it enables real-time validation, which makes it easier to identify and rectify issues.

Conduct Regular Internal Audits

The next preventive strategy is to perform internal audits to identify recurring issues and trends in your billing and coding workflow, resulting in denial code CO 16. You can optimize your claim submission process to increase accuracy based on the audit results.

Focus on Payer-Provider Relationship

Moreover, you can avoid denial code CO 16 by effectively collaborating with the insurance payer. It will help you understand the insurance company’s specific expectations and ensure compliance.

CO 16 Denial Code – Management & Resolution

The best practices we discussed in the previous section will help you prevent getting the denial code CO 16. However, if you still receive it, here’s how you should try to resolve it:

1. Your first step should be to review the claim for billing errors or missing information, including incorrect coding, inaccuracies in patient details, or lack of documentation.
2. Next, you should ensure the inclusion of all necessary information, including accurate diagnosis and procedure codes, patient demographic verification, and supporting documentation.
3. Denial code CO 16 occurs with at least one remark code, explaining additional details regarding why the payer refused reimbursements for the rendered services. Review this code to understand the reason and rectify the issue in the next step.
4. In case there isn’t any remark code in the claim, it is advisable to refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) for guidelines or instructions regarding claim denial 16.
5. Follow the guidelines or instructions you identified in the previous step to address the issue behind the denial. It may require you to provide additional supporting documentation, correct coding errors, or justify the medical necessity of provided services or procedures.
6. Finally, re-check all the details and codes before resubmitting the claim to ensure the issue is resolved and increase your chances of reimbursement.

Bottom Line

Denial code CO 16 should be considered a red flag by medical coding and billing specialists. It signifies missing or incorrect information. However, like all other soft denials, it can be reversed when errors, such as inaccurate patient information, procedural codes, or diagnoses, are rectified and additional documentation is provided. 

You can use preventive strategies, like re-checking claims for potential errors or missing information, implementing automated claim scrubbing software, training staff on the latest coding systems and guidelines, utilizing electronic claim submission, and conducting regular internal audits, to eliminate the CO 16 denial code.  However, if you find it challenging to manage and resolve denial CO 16, you can acquire professional denial management services from a reputable firm like MediBill MD.