Quick Explanation
Denial code CO-116 indicates that the payer has rejected a claim or specific line item because the patient's advance directive on file does not meet the necessary regulatory, legal, or policy-specific requirements. This typically occurs when the document lacks required legal signatures, witnesses, or fails to comply with state statutes or Medicare Conditions of Participation.
Common Causes for CO-116
Denials with code CO-116 typically happen for the following specific reasons:
- The advance directive document is missing mandatory signatures from the patient, designated witnesses, or a notary public as required by state law.
- The document on file is incomplete, outdated, or illegible, making it impossible to verify its legal validity.
- The advance directive was not executed in accordance with the specific state statutes governing the jurisdiction where the medical services were rendered.
- Failure to properly document or update the patient's advance directive status in the electronic health record (EHR) during a hospice, home health, or inpatient admission.
How to Prevent CO-116 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Implement an automated EHR checklist at patient intake or admission to verify that all advance directives are fully completed, signed, dated, and witnessed.
- Conduct regular staff training on state-specific legal requirements for valid advance directives, healthcare proxies, and living wills.
- Establish a prompt scanning and auditing workflow to ensure physical advance directive documents are instantly uploaded and verified in the patient's chart.
- Utilize patient portals to allow patients to upload and verify their advance directives ahead of scheduled admissions or procedures.
Appeal Letter Template for CO-116
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: CO-116 - The advance directive on file does not comply with requirements
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code CO-116: "The advance directive on file does not comply with requirements".
On behalf of our facility, we are appealing the denial of this claim associated with denial code CO-116. A comprehensive audit of the patient's medical record confirms that a legally compliant advance directive was active and on file at the time of service, satisfying the requirements outlined in the Patient Self-Determination Act (PSDA) and Medicare Conditions of Participation under 42 CFR ยง 489.102. The attached documentation contains all required elements, including valid patient and witness signatures that conform to state-specific statutory guidelines. We have enclosed a copy of the fully executed advance directive along with the admission documentation, and we respectfully request that you review these records and reverse this denial to process the claim for immediate payment.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
Stop Writing Appeals Manually
Clausea can read your medical records and generate custom, evidence-based appeals for denial code CO-116 in seconds.
Generate Appeal for CO-116 Now