N 290, N 257, CO 5 AND CO 16 - Denial reason codes

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

Posted in: Denial and action