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CO-227 Denial Code: Patient Didn't Send Requested Info

CO-227 means information the payer requested from the patient, insured, or responsible party was not provided or was insufficient or incomplete. Common examples are coordination of benefits questionnaires and accident details. The claim can usually be reconsidered once the patient responds.

Quick facts

Code
CO-227 (CARC 227)
Status
Active In use since September 21, 2008; last modified September 20, 2009.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The payer holds the claim against the provider while waiting for the patient. Many payers expect the provider not to bill the patient until the information is supplied and the claim is reprocessed.
  • PR (Patient Responsibility): Some payers assign the balance to the patient because the patient did not respond. Check payer rules before billing the patient.
Official description
Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-227 means

CARC 227 says information requested from the patient, insured, or responsible party was not provided or was insufficient or incomplete. It is the member-side counterpart of CARC 226. The payer contacted the member for something only they can supply, did not get an adequate answer, and denied or pended the claim.

The most frequent example is the annual coordination of benefits questionnaire. Many plans periodically ask members whether they have other coverage. If the member ignores the letter, claims can start denying with CARC 227 even though nothing is wrong with the provider’s claim.

X12 requires a remark code with CARC 227. Use it to tell the patient exactly what their insurer is waiting for.

Common causes

  • Unanswered other-insurance questionnaire.
  • Accident details not provided, where the diagnosis suggests an injury and the plan asks how it happened.
  • Dependent verification not completed, such as student status for an adult child.
  • Pre-existing condition or prior coverage questions under some plan types.
  • Payer mail sent to an old address, so the member never saw the request.

How to fix it

  1. Read the remark code to identify what the payer asked the member for.
  2. Contact the patient promptly. Explain what is needed and give them the payer’s phone number or portal link. Many members can complete a COB update over the phone.
  3. Confirm with the payer once the patient responds, then ask for reprocessing. Some payers reprocess automatically; others want the claim resubmitted or a reconsideration filed.
  4. Hold patient billing while the member responds, unless the payer assigned the balance to PR.
  5. Set a follow-up date. If the patient does not respond, follow your financial policy and any payer rules on billing the member.

How to prevent it

  • Ask about other insurance at every visit and update registration records.
  • Tell patients during check-in that their plan may send COB or accident questionnaires and that ignoring them can delay payment.
  • Capture accident information (box 10a-c and box 14) when a visit is injury-related, so the payer has fewer questions.
  • Monitor eligibility responses for COB flags before the visit.

See eligibility and COB denials for more on coordination-of-benefits problems that stall claims.

Remark codes that may appear with CO-227

  • N179 (Additional information has been requested from the member.): The payer asked the member for information and will reconsider on receipt.
  • N686 (Missing/incomplete/Invalid questionnaire needed to complete payment determination.): A questionnaire needed for the payment decision is missing or incomplete.
  • N375 (Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.): The questionnaire was about dependent eligibility, such as a student or disabled dependent.
  • CO-226 (Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.): The information was requested from the provider rather than from the patient.
  • OA-22 (This care may be covered by another payer per coordination of benefits.): The payer believes another plan may be primary, often the reason for a COB questionnaire.
  • CO-32 (Our records indicate the patient is not an eligible dependent.): The payer's records show the patient is not an eligible dependent.

CO-227 FAQ

What information do payers usually request from patients?

Common requests include coordination of benefits (other insurance) questionnaires, accident or injury details, and dependent status verification. The remark code usually names the item.

How do I get a CO-227 claim paid?

Contact the patient, explain what the payer needs, and ask them to respond directly to the payer. Then ask the payer to reprocess the claim once the information is on file.

Can I bill the patient for a CO-227 denial?

Under the CO group, the payer has not assigned the amount to the patient. Many practices send the patient a notice asking them to contact their insurer, rather than a bill, until the claim is reprocessed.

How long does a patient have to respond before CO-227 becomes final?

It depends on the payer. Some reprocess whenever the information arrives, as long as it is within the claim's appeal or reopening limits; others set a firm response deadline in their letter. Ask the payer and track the date.