835 Denial Combination
CO-16+N428
Contractual Obligation · Claim-Level Adjustment
Missing InformationWhat This Combination Means
The claim was submitted with incorrect or missing place of service information, creating a billing error that resulted in denial under contractual terms. The RARC clarifies that the specific submission error is related to place of service, either because it was omitted, coded incorrectly, or does not match the service provided. The payer is indicating this is a preventable submission error covered by the provider's contract terms.
Financial Responsibility
provider writeoff
Provider must write off the denied amount per contractual obligation with the payer. Patient cannot be billed because this is a provider-side submission error.
N/A
Appeal Success
1-3 business days (corrected claim)
Avg. Resolution
Medium
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-16+N428 combination — not generic advice.
- 1
Verify the actual place of service where the service was rendered
Compare the POS code submitted on the original claim against where the service actually occurred and payer coverage policies for that service type
- 2
Correct the place of service code on a new claim submission
Update box 24B (CMS-1500) or loop 2400 SV105 (837) with the accurate POS code that matches both where service occurred and payer requirements
- 3
Submit corrected claim with frequency code 7
File as a replacement claim to replace the original submission with accurate place of service information, ensuring all other claim data remains consistent
Specialty Context
How CO-16+N428 typically presents across different practice types.
Dental
Common when dental procedures are billed with medical POS codes (e.g., office POS 11 instead of dental office POS 11) or when procedures like extractions are performed in settings not covered under the dental plan
Medical
Frequently occurs when office visits are billed with facility POS codes, telehealth services use incorrect POS 02 versus POS 10, or when procedures require specific settings like ASC (24) versus office (11) for coverage
Behavioral Health
Common when teletherapy is billed with in-office POS 11 instead of telehealth POS 02 or 10, or when intensive outpatient programs use incorrect facility codes that don't match contracted service locations
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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