Something the payer needed was missing or wrong on the claim.
PR: Patient responsibility. This one goes on the patient statement.
So the balance is billable to the patient, provided your advance notice was in order. Check that before the statement goes out. Billing a patient for something you contractually agreed to absorb is the expensive mistake on this code.
The same code, a different prefix. 16 also arrives as CO 16. The reason for the denial is the same. The prefix decides who pays for it, so the next step is not the same. If your remit says CO 16, read that page instead.
Fix and resubmit. This is a correction, not an appeal. Appealing burns the deadline.
In the order we see it.
The RARC printed beside this code names the actual missing item.
A missing or invalid NPI, referring provider, modifier or accident date.
Read the RARC beside it; that names the missing item. Correct and resubmit.
The documentation, not the argument.
The common mistake. Do not appeal this. It is a correction, and an appeal spends the timely-filing clock on a claim that would have paid on resubmission.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
Something the payer needed was missing or wrong on the claim. So the balance is billable to the patient, provided your advance notice was in order. Check that before the statement goes out. Billing a patient for something you contractually agreed to absorb is the expensive mistake on this code.
This is our plain-English wording, not the official X12 text. X12 asserts copyright over the published descriptions, so we write our own and say what it means for the money rather than restating the code.
The adjustment code says the claim was reduced. The remark code printed next to it says why, and it is the one that tells you what to send back.
| Remark | What it means |
|---|---|
| N56 | The procedure code does not match what was done, or was not valid on that date of service. |
| N59 | The payer has pointed you at the provider manual rather than naming the rule it applied. |
| N822 | A modifier the payer needed was missing from the procedure. |
| N290 | The rendering provider identifier is missing, incomplete or wrong. |
| MA130 | The claim was unprocessable, so it was never adjudicated and carries no appeal rights at all. |
| N211 | The payer is telling you this particular decision carries no appeal rights. |
| M51 | A procedure code is missing, incomplete or not valid. |
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