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CO-P16 - Denial Journal
CARC

CO-P16

What This Code Means

Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers’ Compensation only. (Use with Group Code CO or OA)

Common Causes

  • Authorization/referral not obtained before the service
  • Authorization obtained but for different codes, units, or dates than billed
  • Authorization expired before the service date

How to Resolve or Appeal

  1. Check the payer portal for an authorization on file and compare it exactly to what was billed
  2. Request a retroactive authorization if the payer allows it
  3. Appeal with clinical documentation if retro-authorization is denied

More Denial Codes to Check

CARC CO-39 Services denied at the time authorization/pre-certification was requested CARC CO-185 The rendering provider is not eligible to perform the service billed CARC CO-243 RARC M91 CARC CO-302 CARC CO-15 CARC CO-197 Precertification/authorization/notification absent RARC M130 RARC MA51 CARC CO-213 CARC CO-183 The referring provider is not eligible to refer the service billed CARC CO-287

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

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