Denial Code PR-16
Claim/service lacks information or has submission/billing error(s).
Source: X12 Claim Adjustment Reason Codes (CARC) & Group Codes. Maintained by the D3rx Clinical Billing Team.
What PR-16 means
The same lacks-information problem as CO-16, reported under the patient-responsibility group — often because information the PATIENT needed to supply (coordination of benefits, accident details, a form) is missing. The paired remark names exactly what's needed.
Why PR-16 happens
- Patient-supplied information (COB, accident/injury details) missing or incomplete
- A required form or questionnaire not completed by the patient
- A missing or invalid data element the claim can't be processed without
- Subscriber/identification information that doesn't match the payer record
What to do when you get PR-16
- 1Read the paired remark code — it pinpoints the missing or invalid information
- 2If the gap is patient-supplied (COB, accident details, a form), obtain it from the patient
- 3Correct or add the named element and resubmit, or request reprocessing once the patient responds
- 4Validate identifiers and required fields before resubmitting
Got this denial right now?
Fix & resubmit: see the PR-16 correction steps
PR-16 clears with a corrected claim, not an appeal. Ask D3 walks you through the exact fix — free, no signup.
PR group code: who absorbs the charge
Patient Responsibility — May be billed to the patient.
A PR adjustment is the patient's liability — a deductible, coinsurance, copay, or a non-covered amount the patient owes. It is collectible directly from the patient, ideally after advance notice for any non-covered service.
Appeal, correct, or write off PR-16?
PR-16 is a corrected-claim/information fix, not an appeal: supply the missing information (often something only the patient can provide) and resubmit or request reprocessing. The paired remark tells you exactly what to fix. Treat any balance as the patient's only after confirming the information is genuinely theirs to provide and remains outstanding.
Timing & deadlines
Resubmit within the payer's timely-filing limit (Medicare 12 months from date of service; commercial ~90-180 days). When the gap is patient-supplied, document your outreach so the timely-filing clock is protected while you wait.
Example
A claim returns PR-16 with a remark indicating the payer's coordination-of-benefits questionnaire wasn't completed by the patient. Having the patient complete it and then requesting reprocessing clears the claim.
Prevent PR-16 going forward
- Collect COB and accident/injury details at registration
- Have patients complete required payer forms before or at the visit
- Run a required-field scrubber before submission
- Follow up promptly with patients for any information the payer needs
Code families most affected
- Claims needing patient-supplied COB or accident information
- All claim types (CARC 16 is data-element agnostic)
- Services requiring a completed patient form/questionnaire
Related codes
Payer notes
CARC 16 carries the PR group code when the missing information is the patient's to provide (e.g., COB). It still must be accompanied by a remark naming the specific field — and it's resolved by supplying that information, not by appealing.
Fix this PR-16 denial the right way
PR-16 is resolved with a corrected claim, not an appeal. Ask D3 gives you the exact correction steps — free, backed by CMS, Medicare, and major-payer data.
Medical billing disclaimer
CARC/RARC definitions are the standardized X12 set; group-code semantics follow the X12 Claim Adjustment Group Code standard. Filing and appeal windows vary by payer — the standard anchors shown (Medicare redetermination 120 days from the remittance; Medicare timely filing 12 months from date of service; most commercial payers ~90-180 days) are general references, not a guarantee for any specific plan. Always confirm the rule in the payer's provider manual before acting. D3rx is not responsible for claim outcomes.