835 Denial Combination
CO-16+MA27
Contractual Obligation · Claim-Level Adjustment
What This Combination Means
Missing or incomplete information — the member's name or ID on the claim does not match the payer's enrollment file. MA27 specifically flags a mismatch between the submitted subscriber/patient demographics and what the payer has on record. This is a front-end edit failure, not a clinical denial.
92%
Appeal Success
3-7 days
Avg. Resolution
Easy
Difficulty
Yes
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-16+MA27 combination — not generic advice.
- 1
Run a real-time eligibility verification (270/271) for the date of service to get the exact name and ID the payer has on file.
- 2
Compare the returned subscriber name and member ID to what was submitted on the claim.
- 3
Correct any discrepancies — common errors include transposed characters, missing suffix (Jr./Sr.), or old member ID after a plan switch.
- 4
Update your practice management system with the corrected demographics.
- 5
Resubmit as a corrected claim (frequency 7) with the verified member name and ID.
Specialty Context
How CO-16+MA27 typically presents across different practice types.
Dental
Check Box 11 (subscriber ID) and Box 12 (member name) on the ADA form against the insurance card exactly — including hyphens, suffixes, and middle initials.
Medical
Verify Loop 2010BA (subscriber name NM103/NM104) and member ID (NM109) against the eligibility verification response. Run a new eligibility check to confirm current enrollment.
Behavioral Health
Confirm the member ID in your billing system matches the current ID on the patient's insurance card — IDs often change at plan renewal. Re-verify eligibility at each visit.
Individual Code References
View the standalone definition for each code in this combination.
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