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.

Avoiding/Correcting This Error

Certain services require the submission of the ordering physicians or referring physician’s name and NPI. 

Submission of this information is conditional depending on the type of service provided. Definition of ordering or referring physician:

• A referring physician is one who requests an item or service for the beneficiary for which payment is made under the Medicare Program.
• An ordering physician is one who orders services for the patient such as diagnostic laboratory tests, clinical laboratory tests, pharmaceutical services or durable medical equipment services.

All claims for Medicare-covered services and items that are a result of a physician’s order or referral must include the ordering/referring physician’s name and NPI in Item 17 and 17b of the CMS-1500 claim form or electronic equivalent. 

This includes:

• Medicare-covered services and items that are the result of a physician’s order or referral
• Parenteral and enteral nutrition
• Immunosuppressive drug claims
• Hepatitis B claims
• Diagnostic laboratory services
• Diagnostic radiology services
• Portable x-ray services
• Durable medical equipment
• When the ordering physician is also the performing physician (as often is the case with in-office clinical laboratory tests)

Verify Item 17 and 17b of the CMS-1500 claim form or electronic equivalent to ensure the information entered was correct/populated and resubmit the claim with the correction(s).     

Note: Since, this is considered a rejection you will not have the option to reopen/appeal the claim.