Claim/service lacks information or has submission/billing error(s)

Why this happens on dental claims

• Missing tooth numbers, quadrants, arch, or surface data on procedures that require them
• Crowns, buildups, scaling and root planing, and implants submitted without required attachments such as radiographs, periodontal charting, or narratives
• Subscriber ID, group number, or provider fields left incomplete after a plan change the office did not catch

How to appeal CO-16

1. Read the remark codes on the ERA to identify the exact missing element, and call the payer if no remark code was provided
2. Gather the missing data or attachment from the chart
3. Submit a corrected claim with the missing information rather than a formal appeal, referencing the original claim number
4. Confirm receipt within two weeks, because corrected claims are the ones most often lost
5. Calendar the payer's correction deadline, which is often shorter than the appeal deadline

How to prevent it

• Turn on clearinghouse and PMS validation edits for tooth, surface, and attachment requirements by code
• Keep a per-payer attachment grid at charge entry so required radiographs and narratives go out with the first claim