RARC N716: Patient Medical Chart Missing from Claim
The claim cannot be processed because the patient's medical chart was not submitted — locate the chart records and resubmit with the documentation attached.
What Does RARC N716 Mean?
RARC N716 indicates that the payer requires the patient's medical chart to adjudicate the claim and it was not included with the submission. Unlike requests for specific clinical notes (N710), summary documents (N712), or reports (N714), N716 requests the broader medical chart — which may include the full set of clinical records relevant to the billed services such as progress notes, diagnostic results, treatment plans, medication lists, and provider orders.
Payers typically request the full medical chart when conducting detailed claim reviews, audits, or when the complexity of the case requires comprehensive clinical context to make a coverage determination. This is more common with high-dollar claims, inpatient stays, complex outpatient procedures, or claims flagged for prepayment or post-payment review.
The request for the medical chart does not imply the services were inappropriate. It means the payer needs more comprehensive documentation than what was submitted to evaluate the claim properly. Until the chart is provided, the claim will remain in a pending or denied status.
What to Do
Gather the relevant portions of the patient's medical chart for the dates of service in question. This typically includes encounter notes, diagnostic orders and results, treatment plans, medication administration records, nursing notes (for inpatient claims), and any other documentation relevant to the billed services. Ensure all documents are legible, properly identified with the patient's information, and organized chronologically.
Submit the chart to the payer following their documentation submission guidelines, including a cover letter that references the claim number and the N716 remark code. Be mindful of HIPAA minimum necessary standards — submit the records relevant to the claim rather than the patient's entire lifetime medical history unless specifically requested. Track the claim after resubmission, as payer review of comprehensive chart documentation may take longer than standard claims processing.
Common Scenarios
- A high-dollar surgical claim is selected for prepayment review and the payer requires the complete medical chart for the admission
- An audit of outpatient therapy claims requests the full patient chart to evaluate the medical necessity and progress across the course of treatment
- A complex chronic care management claim requires the medical chart to document the breadth of services provided over the billing period
- A post-payment review identifies a claim for detailed audit and the payer requests the chart to validate the services billed
Commonly Paired With
RARC N716 commonly appears alongside these CARC denial codes:
| Code | Name | |
|---|---|---|
| CO-252 | Attachment Required to Adjudicate Claim | → |