CARC Code
16
Claim/service lacks information or has submission/billing error(s).
87%
Recovery Rate
5-10 days
Avg. Resolution
Easy
Difficulty
Very Common
Frequency
Recommended Action
Identify missing information and resubmit corrected claim
Step-by-Step Resolution
- 1
Review the Remittance Advice Remark Code (RARC) paired with this denial for the specific missing field
- 2
Pull the original claim and identify the incomplete or incorrect data element
- 3
Correct the claim in your practice management system
- 4
Resubmit as a corrected claim (frequency code 7) within the timely filing window
- 5
Verify resubmission was received by the payer within 5 business days
- 6
If denied again, call provider relations to identify the exact field causing the rejection
Common Remark Codes (RARC)
These RARC codes often appear alongside CARC 16 on remittance advice.
→ Verify CPT/CDT code is valid and fully formed
→ Check payer portal for claim edit requirements
→ Add facility NPI and address in Box 32 of CMS-1500
→ Verify patient member ID and date of birth match payer records
Payer-Specific Notes
How major payers handle CARC 16 in practice.
Delta Dental
Tooth number is required for all procedure codes involving specific teeth; missing tooth number is the #1 trigger
MetLife Dental
X-ray date is required for crown and bridge procedures; include date in narrative
United Concordia
NPI must match the credentialed rendering provider on file; verify NPI type
Common 835 Combinations
CARC 16 most often appears with these Group Code + RARC combinations on 835 remittances.
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