116Denial Code (CARC)Active
CO 116 Denial Code - Fix Advance Notice Compliance
Code 116 indicates that the advance indemnification notice signed by the patient did not meet the required standards. This means that the document intended to inform the patient of potential non-coverage was either incomplete or incorrect, leading to the denial.
Who Pays: Group Code Liability
Under code 116, the group code CO applies, meaning the provider must write off the amount, and the patient cannot be billed for this service.
Why Claims Get Code 116
- The advance indemnification notice was missing required information.
- The notice was not signed by the patient before the service was provided.
- The wrong form was used for the indemnification notice.
- The notice was not given in the correct timeframe before the service.
- The notice did not properly explain the non-covered service.
How to Fix & Resubmit
- Verify whether the correct advance indemnification notice was used and filled out completely.
- Check if the notice was signed by the patient prior to the service date.
- Ensure the notice included all required information and was presented within the appropriate timeframe.
- If errors are found, submit a corrected claim with the proper documentation.
- If applicable, contact the payer to discuss potential resolution options if the notice was compliant.
Corrected Claim or Appeal?
For code 116, a corrected claim is appropriate if the original notice was compliant but improperly documented. If the notice was non-compliant, this is a contractual adjustment and cannot be appealed.
Preventing Future 116 Denials
- Use a checklist to ensure all indemnification notices meet requirements before the service is rendered.
- Train staff on the importance of completing indemnification notices correctly and on time.
- Regularly review and update forms to comply with current regulations.
- Implement a verification step to confirm patient signatures on all advance notices.