Medicare Denial reason code co 16 & N290
Denial Message
• Claim/service lacks information which is needed for adjudication (16)
• Missing/incomplete/invalid rendering provider identifier (290)
Reason for denial
• The claim was filed with an invalid or missing rendering NPI
How to resolve and avoid future denials
• Refile the claim with the valid rendering provider’s NPI in Item 24J of the CMS 1500 claim form
• For assistance with obtaining NPIs
o NPI Registry
• https://nppes.cms.hhs.gov
Denial message co 16 N257
• Claim/service lacks information which is needed for adjudication (16)
• Missing/incomplete/invalid billing provider primary identifier (257)
Reason for denial
• The claim was filed with an invalid or missing NPI
How to resolve and avoid future denials
• File claims with the valid billing provider NPI
• Verify the appropriate billing provider NPI is listed in Item 33 of CMS 1500 claim form
• Billing for group – use group NPI
• Solo practitioner – use individual NPI
Denial message code CO 5
• The procedure code/bill is inconsistent with the place of service (05)
Reason for the denial
• Service was rendered at a facility/location that was inappropriate or invalid
How to resolve and avoid future denials
• Verify that the procedure code/bill is consistent with the place of service
• Resubmit as a new claim with a procedure code consistent with the place of service
Tags:
Denial and action