835 Denial Combination
CO-16+M76
Contractual Obligation · Service-Line Level Adjustment
What This Combination Means
Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Missing/incomplete/invalid diagnosis or condition.
N/A
Appeal Success
7-14 days
Avg. Resolution
Medium
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-16+M76 combination — not generic advice.
- 1
Verify the Local Coverage Determination (LCD), LCD Policy Article for the applicable diagnosis codes required for specific policies
- 2
If no diagnosis, add diagnosis and rebill claim
- 3
Suppliers may do a self service reopening in the Noridian Medicare Portal to change the diagnosis.
Specialty Context
How CO-16+M76 typically presents across different practice types.
Dental
Medical
Behavioral Health
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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