Missing Claim Information

Claim/service lacks information or has submission/billing error(s) which are needed for adjudication. Additional details are required before the payer can process payment.

What This Means in Behavioral Health

CO-16 is a catch-all on BH institutional claims—missing admit date, diagnosis pointer, attending NPI, taxonomy, occurrence codes, or value codes on UB-04 claims. Outpatient mental health claims deny with CO-16 when referring provider, place of service, or units are omitted.

Root Causes

• Required UB-04 field blank (admit type, source, occurrence code for MSP)
• Invalid or missing attending/rendering provider NPI for the billed service
• Diagnosis code not valid for date of service or not acceptable to payer
• Units or dates of service missing on program per diem lines
• Claim frequency/type incorrect for inpatient vs outpatient BH context

Prevention Tips

• Use pre-submission scrubbers tuned to UB-04 and CMS-1500 BH required fields
• Validate NPI, taxonomy, and facility location against active payer enrollment
• Map diagnosis codes to LOC and payer medical necessity lists before billing
• Audit sample institutional claims weekly during onboarding of new programs