Reason Code: CO-16

Error Description:

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

Remark Code N265 – Missing/incomplete/invalid ordering provider primary identifier.

Remark Code N276 – Missing/incomplete/invalid other payer referring provider identifier.

Avoiding/Correcting This Error

Certain services require the name and NPI of the ordering or referring physician, depending on the service type. Definitions:

• Referring Physician: Requests an item or service for a Medicare beneficiary.
• Ordering Physician: Orders patient services like diagnostic tests, pharmaceutical services, or durable medical equipment.

All claims for services or items resulting from a physician’s order or referral must include the physician's name and NPI in Item 17 and 17b of the CMS-1500 claim form or electronic equivalent. This applies to:

• Medicare-covered services and items from a physician's order or referral
• Parenteral and enteral nutrition
• Immunosuppressive drugs
• Hepatitis B claims
• Diagnostic laboratory and radiology services
• Portable X-ray services
• Durable medical equipment
• Services where the ordering physician is the performing physician
• Services incident to those of a physician or NPP

Verify and correct the information in Item 17 and 17b of the CMS-1500 claim form before resubmitting the claim.