835 Denial Combination

CO-16+N386

CO

Contractual Obligation · Service-Line Level Adjustment

Missing Information

What This Combination Means

The claim contains billing errors or missing information related to a service that is subject to a National Coverage Determination. The payer has denied the claim under contractual obligation because the submission did not meet the information requirements specified in the applicable NCD. The provider must write off this amount and cannot rebill the patient.

Financial Responsibility

provider writeoff

The provider must absorb this adjustment as a contractual write-off. The billing error or missing information related to NCD requirements makes this a contractual adjustment that cannot be transferred to the patient.

N/A

Appeal Success

7-14 days (corrected claim)

Avg. Resolution

Medium

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-16+N386 combination — not generic advice.

Not Appealable:This is a contractual adjustment for a billing error or missing information related to NCD requirements, not a coverage or medical necessity denial subject to appeal.
  1. 1

    Access the specific National Coverage Determination cited

    Retrieve the NCD from www.cms.gov/mcd/search.asp or request from the contractor to identify exact information requirements for the submitted service

  2. 2

    Identify the missing or erroneous information elements

    Compare the original claim submission against the NCD requirements to determine which mandatory information was missing or incorrectly reported

  3. 3

    File a corrected claim with complete NCD-required information

    Submit a corrected claim including all information elements mandated by the NCD, ensuring compliance with all documentation and coding requirements specified in the policy

Specialty Context

How CO-16+N386 typically presents across different practice types.

Dental

Medical

Common for advanced imaging, laboratory tests, durable medical equipment, and surgical procedures with specific NCD coverage criteria requiring particular diagnosis codes, modifiers, or supporting documentation elements

Behavioral Health

May occur for specialized psychiatric services, substance abuse treatments, or psychological testing that have NCD requirements for specific diagnostic information or treatment setting details

Individual Code References

View the standalone definition for each code in this combination.

CARC 16RARC N386

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

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Synthesized from official definitions — not from training data

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