AGAR Guide
CARC163ReferenceCurrentVerified Aug 15, 2026

CARC 163

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 attachment or other documentation referenced on the claim was not received.

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

  • Supporting documentation not sent with the claim
  • Documentation sent to the wrong address
  • Fax/portal submission failed

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. Confirm what documentation was requested
  2. Check submission logs for the attachment

AR Guide knowledge

Recommended action

  1. Resubmit the claim with the requested documentation
  2. Use the payer's preferred documentation submission channel

Appeal template

No code-specific template yet

No downloadable template targets CARC 163 specifically. Browse all appeal letter templates — or follow the recommended workflow above.

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 163 on the ERA/EOB. Select the one on your line to focus the workflow, or use the list as a lookup.

  • RARCN170A new/revised/renewed certificate of medical necessity is needed.Obtain a current CMN and resubmit, or appeal with the valid CMN for the service dates.
  • RARCN29Missing documentation/orders/notes/summary/report/chart.Send the requested documentation through the payer's preferred channel and reference the claim number. Track the submission so it can be proven later.
  • RARCM129Missing/incomplete/invalid indicator of x-ray availability for review.Verify the x-ray availability indicator was submitted and resubmit with the required indicator.
  • RARCN762This facility is not certified for Tomosynthesis (3-D) mammography.Confirm the facility's certification for the specific service. If certified, appeal with the certification documentation.
  • RARCN26Missing itemized bill/statement.
  • RARCM29Missing operative note/report.
  • RARCM30Missing pathology report.
  • RARCM31Missing radiology report.
  • RARCN393Missing progress notes/report.
  • RARCN3Missing consent form.
  • RARCM60Missing Certificate of Medical Necessity.
  • 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.

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