835 Denial Combination

CO-16+N258

CO

Contractual Obligation · Service-Line Level Adjustment

Missing Information

What This Combination Means

The claim was denied because the billing provider or supplier address submitted was missing, incomplete, or invalid. This is a contractual adjustment that requires the provider to write off the amount, though it can typically be corrected and resubmitted. The payer cannot process the claim without valid billing provider address information in their system.

Financial Responsibility

provider writeoff

The provider must write off this amount per contractual obligation with the payer. The patient cannot be billed for this adjustment, as it results from a provider submission error.

N/A

Appeal Success

3-5 business days (corrected claim)

Avg. Resolution

Medium

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-16+N258 combination — not generic advice.

Not Appealable:This is a correctable billing error, not a coverage or payment determination, so the appropriate remedy is corrected claim resubmission rather than appeal.
  1. 1

    Verify the current billing provider/supplier address on file with the payer

    Contact payer provider services or check online portal to confirm what address is enrolled and active in their system for your NPI/Tax ID combination

  2. 2

    Update claim with complete and valid billing provider address in Loop 2010AA (Billing Provider Name) per payer enrollment records

    Ensure address includes all required elements: street address, city, state, and ZIP code matching exactly what payer has on file

  3. 3

    Resubmit as a corrected claim using Claim Frequency Code 7 with original claim reference number

    Include original claim number in CLM05-3 to ensure proper replacement processing and avoid duplicate denial

Specialty Context

How CO-16+N258 typically presents across different practice types.

Dental

Dental claims require the billing dentist address to match exactly what is enrolled with the dental plan; group practices must ensure the correct service location vs. billing address distinction

Medical

Medical practices with multiple locations or billing entities must ensure the correct billing TIN/NPI address combination is used; facility-based providers should verify whether facility or professional address is required

Behavioral Health

Behavioral health providers, especially those in telehealth or multi-state practices, must ensure billing address matches the state of licensure and payer enrollment for each claim

Individual Code References

View the standalone definition for each code in this combination.

CARC 16RARC N258

Medicare Contractor Guidance for CARC 16

FCSO + Noridian + uhc + aetna + bcbs_az

This 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.

CMS guidelines for completion of form CMS-1500 in the Medicare Claims Processing Manual (100-04), Chapter 26SPOTFee Schedule Lookup ToolCMS laboratory demographics lookupModifier lookup toolNoridian Medicare PortalNMPIVRSame or SimilarPECOSPDAC

Need to resolve this denial?

Get a complete resolution plan with appeal guidance for this exact combination in seconds.

Generate a free resolution plan & appeal letter →

Synthesized from official definitions — not from training data

Was this helpful?
← Back to Combo LookupBrowse All Codes →