CO-226: Provider Information Not Provided or Insufficient
Supply the missing provider information and resubmit. Do not appeal.
What Does CO-226 Mean?
With CO (Contractual Obligation), the missing provider information is the provider's responsibility. Supply the required data and resubmit. Do not appeal.
CARC 226 indicates that the claim is missing essential provider information that the payer needs to process it. This is broader than NPI-specific denials (206, 207, 208) — it encompasses any provider data element that is missing or insufficient, including taxonomy codes, provider addresses, group practice information, specialty designations, or other required identifiers.
This denial typically results from incomplete provider setup in the billing system, changes in payer requirements for provider data elements, or errors in claim form completion. The fix is to identify what information is missing, supply it, and resubmit.
Common Causes
| Cause | Frequency |
|---|---|
| Failed to respond to payer's request for additional information The payer requested additional documentation or information from the provider and the provider did not respond within the required timeframe | Most Common |
| Submitted information was incomplete or insufficient The provider responded to the information request but the response did not include all required documentation or was missing key details | Most Common |
| Medical records not submitted timely The payer requested medical records for review but they were not provided within the specified deadline | Common |
| Missing documentation for additional development The claim was placed in additional development and the provider did not submit the required supporting documentation | Common |
| Payer request went unnoticed or was misrouted The payer's information request was not received or was routed to the wrong person in the provider's office | Occasional |
How to Resolve
- Identify what is missing Determine the specific provider data element needed.
- Supply and resubmit Add the information and resubmit the claim.
Appeal if the requested information was previously submitted within the required timeframe. Include proof of prior submission (fax confirmations, certified mail receipts, electronic submission confirmations) and reattach the requested documentation. If the information was not previously submitted, submit it now with the appeal.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-226:
| RARC | Description |
|---|---|
| N283 | Missing/incomplete/invalid point of pick-up address. Submit the specific missing information identified in the remark code → |
| MA130 | Your claim contains incomplete and/or invalid information, and no appeal rights are afforded. Submit the requested information and resubmit the claim → |
| N479 | Missing/incomplete/invalid information. Review the specific information gap and submit complete documentation → |
How to Prevent CO-226
- Ensure all required provider information is configured in your billing system
- Verify provider data completeness before claim submission
- Stay current on payer requirements for provider information elements
- Conduct regular audits of provider records for completeness
General Prevention
- Implement a system to track and respond to all payer information requests within required timeframes
- Designate staff responsible for monitoring and responding to additional development requests
- Submit complete medical records and supporting documentation with the initial claim when possible
- Respond to payer information requests within 48 hours to avoid missing deadlines
- Maintain organized records that can be quickly retrieved when payers request documentation
- Use electronic documentation submission to ensure timely delivery and confirmation of receipt
Also Filed As
The same CARC 226 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.mdclarity.com/denial-code/226
- https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
- Codes maintained by X12. Visit x12.org for official definitions.