164Denial Code (CARC)Active
CO 164 Denial Code: Missing Documentation Fixes
Code 164 means the payer did not receive the necessary attachment or documentation referenced in the claim before their deadline. Without this timely documentation, the claim cannot be processed as submitted.
Who Pays: Group Code Liability
Typically, code 164 will appear with a CO group code, meaning the provider must absorb the cost and cannot bill the patient. However, if the payer's policy allows, it might appear with a PR group code, making it patient responsibility, but this is less common.
Why Claims Get Code 164
- The required documentation was not attached to the claim submission.
- The documentation was sent after the payer's deadline.
- There was a mismatch between the claim's reference to documentation and the actual submission.
- The payer's system did not register the received documentation.
- The documentation was incomplete or illegible.
How to Fix & Resubmit
- Verify which documentation was missing or late by checking the claim and payer's requirements.
- Locate the correct and complete documentation referenced in the claim.
- Ensure the documentation is legible and complete before resubmitting.
- Submit the documentation through the payer's preferred method, confirming receipt if possible.
- Follow up with the payer to ensure the documentation has been processed and the claim is being reconsidered.
Corrected Claim or Appeal?
For code 164, submit a corrected claim with the necessary documentation attached. An appeal is generally not needed unless there is a dispute over the timeliness or completeness of the original submission.
Preventing Future 164 Denials
- Ensure all required documentation is attached before initial claim submission.
- Maintain a checklist of necessary documents for each payer to avoid missing attachments.
- Submit documentation promptly to meet payer deadlines.
- Confirm receipt of documentation when submitted separately from the claim.