AGAR Guide
CARC16ReferenceCurrentVerified Aug 15, 2026

CARC 16

AR Guide workflow

Step-by-step: Missing Information

✓ Workflow verified Aug 15, 2026 · Verified via review of official sources and AR Guide practice testing — not payer policy. View the full guide

  1. VerifySteps 1–10

    1. Remark code(s) on the ERA/EOB — they identify the exact issue

    2. Original submission vs. what the payer received

    3. Edit or scrubber report for the flagged element

    4. Missing data vs. invalid data

    5. Unprocessable (MA130) vs. a true denial

    6. CARC 16 and the accompanying remark code

    7. Read the remark code(s) that accompany the denial to identify the exact issue

    8. Compare the claim to the original submission

    9. Check the claim scrubber or edit report for the flagged element

    10. Confirm the corrected claim clears the original edit

  2. ActSteps 11–14

    1. Fix the specific flagged element and resubmit

    2. Do not resubmit an unchanged claim expecting a different result

    3. If the claim is unprocessable (e.g., MA130), correct it rather than appeal

    4. Document what was corrected so the resubmission can be audited

  3. Document & QASteps 15–20

    1. The original claim and the corrected version

    2. The remark code that identifies the missing element

    3. Edit or scrubber report showing the flagged field

    4. Document the correction reason on the account

    5. Verify the resubmitted claim clears the original edit

    6. Track recurring edit failures to fix the source of the error

AR Guide explanation

What it means

The payer could not process the claim as submitted because required information was missing or the claim had a submission or billing error. A remark code should accompany this code to explain what is missing.

AR Guide knowledge

Common denial category

Missing Information — The claim was missing required information or had a submission or billing error, so the payer could not process it. This is usually a correction, not an appeal.

AR Guide knowledge

Most common causes

  • Missing or invalid modifier
  • Incorrect or missing patient/provider information
  • Incomplete coding or missing required fields
  • Claim rejected by an edit before adjudication

AR Guide knowledge

Action in your PM/EMR system

In your PM system: open the original claim, find the field the remark code names (patient, provider, modifier, POS, diagnosis pointer…), correct it, and resubmit with frequency code 7 (Replace). Do not create a new claim — that is how duplicates are born.

Illustrative scenario

Real-world example

An office visit (CPT 99213) was submitted with the patient's old subscriber ID. The payer denied with CARC 16 + RARC M79 because the subscriber ID did not match their records. The fix: correct the subscriber ID in the PM system and resubmit with frequency code 7.

Example — not a claim about any specific payer or account.

AR Guide knowledge

What AR should verify

  1. Read the remark code(s) that accompany CARC 16 to identify the exact issue
  2. Compare the claim to the original submission
  3. Check the claim scrubber/edit report for the flagged element

AR Guide knowledge

Recommended action

  1. Fix the specific flagged element and resubmit
  2. Do not resubmit an unchanged claim expecting a different result
  3. If the claim is unprocessable (e.g. MA130), correct it rather than appeal

Appeal template

No code-specific template yet

No downloadable template targets CARC 16 specifically. Browse all appeal letter templates — or follow the recommended workflow above.

AR Guide knowledge

Escalation

  • If the payer cannot identify the missing element, escalate to a supervisor with the full claim and remark details.

AR Guide knowledge

QA checkpoint

  • Document what was corrected so the resubmission can be audited
  • Verify the resubmitted claim clears the original edit

About this guidance: Note

AR Guide knowledge is general reference content written by our team — it is not payer-specific policy and never replaces the payer’s documentation or your contract. Always confirm specifics with the payer.

Priority 2

Commonly paired RARCs

RARCs commonly accompany CARC 16 on the ERA/EOB. Select the one on your line to focus the workflow, or use the list as a lookup.

  • RARCM119Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).Verify the NDC against the dispensed drug, correct it in the drug claim line, and resubmit — this is a correction, not an appeal.
  • RARCM79Missing/incomplete/invalid charge.Confirm the charge amount, correct it, and resubmit — the fix is the charge field, not an appeal.
  • RARCM51Missing/incomplete/invalid procedure code(s).Verify the procedure code against the documentation, correct it, and resubmit — a correction path.
  • RARCMA130Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.This is not an appeal situation — fix the flagged issue and resubmit. Resubmitting the identical claim will return the same result.
  • RARCN38Missing/incomplete/invalid place of service.Correct the place of service code and resubmit.
  • RARCN57Missing/incomplete/invalid prescribing date.Verify the prescription date and resubmit with the correct date.

Priority 3

Payer-specific nuance

How major payers handle this denial — what AR Guide has verified, and what you must confirm with the payer. We never publish payer handling we have not verified.

Medicare

The exact data each payer requires, and how it must be submitted, varies. Read the remark code carefully and correct only what was flagged — verify the required format with the payer rather than guessing.

Medicaid

The exact data each payer requires, and how it must be submitted, varies. Read the remark code carefully and correct only what was flagged — verify the required format with the payer rather than guessing.

UnitedHealthcare

The exact data each payer requires, and how it must be submitted, varies. Read the remark code carefully and correct only what was flagged — verify the required format with the payer rather than guessing.

Aetna

The exact data each payer requires, and how it must be submitted, varies. Read the remark code carefully and correct only what was flagged — verify the required format with the payer rather than guessing.

Cigna

The exact data each payer requires, and how it must be submitted, varies. Read the remark code carefully and correct only what was flagged — verify the required format with the payer rather than guessing.

Anthem (BCBS)

The exact data each payer requires, and how it must be submitted, varies. Read the remark code carefully and correct only what was flagged — verify the required format with the payer rather than guessing.

Did this resolve your denial?

Help us keep this accurate

Report an error in this code’s guidance

Spotted something outdated or incorrect in the AR Guide guidance or the official description? Flag it — the report becomes a review item for our team and never changes the published page directly.

Do not include patient/member information or PHI — no patient names, member IDs, claim numbers, dates of birth or clinical information. This tool never stores PHI, and the server rejects it.