CO-226: Provider Information Not Provided or Incomplete

What Does CO-226 Mean?

CO-226 is the standard pairing for this code. The provider's failure to provide requested information results in a contractual write-off. You cannot bill the patient for this denial because it was caused by the provider's non-response, not by a coverage or eligibility issue. The financial responsibility for resolving this denial falls entirely on the provider's billing operation.

CARC 226 is a provider-facing information request denial. The payer sent your practice a request for additional information — medical records, clinical documentation, prior authorization support, or other data — and your response was either missing, late, or insufficient. The payer cannot process the claim without this information, so the claim was denied.

This denial is distinct from CARC 227 (patient/insured did not provide information) and CARC 228 (information not provided to a previous payer). CARC 226 specifically targets the billing or rendering provider's failure to respond to a payer information request. The accompanying remark code (RARC or NCPDP Reject Reason Code) will specify what information was requested — at least one remark code is required when this CARC is used.

The most common scenario is a Development Additional Documentation Request (ADR) from Medicare or a medical records request from a commercial payer that was either not received by the provider, lost in internal routing, or responded to after the deadline. Communication breakdowns are a leading root cause — the request may have been sent to an outdated address or fax number, received by the wrong department, or simply buried in the mail. Practices with a dedicated workflow for tracking and responding to payer information requests see significantly fewer CARC 226 denials.

Common Causes

How to Resolve

Identify what information the payer requested, gather the documentation, and submit it to the payer with a request for claim reprocessing.

1. Identify the request and deadline Review the denial to find what was requested and when. Check if the original request was received. If the deadline has passed, determine whether an extension or good cause exception may be available.
2. Compile and submit documentation Gather the specific documentation requested, ensure it is complete, and submit to the payer. Include a cover letter requesting claim reprocessing and explaining any delays in response.
3. Verify contact information with the payer Confirm that the payer has your correct mailing address, fax number, and electronic contact information on file. Update any outdated information to prevent future requests from being misdirected.
4. Appeal if needed If the payer denies reprocessing, file a formal appeal with proof that the information has been submitted. Include evidence of any communication breakdowns that contributed to the original non-response.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-226:

How to Prevent CO-226

• Establish a dedicated workflow for tracking and responding to all payer information requests with defined deadlines and escalation procedures
• Designate a single point of contact for ADRs and medical record requests, and ensure the payer has this contact on file
• Set up automated alerts and follow-up reminders for pending payer requests before deadlines expire
• Regularly audit payer correspondence to catch unanswered requests before they become denials
• Implement a document management system that enables rapid retrieval of medical records
• Verify and update your practice's contact information with all payers annually

General Prevention

• Establish a dedicated workflow for tracking and responding to payer information requests with defined response deadlines and escalation procedures
• Maintain current contact information with all payers to ensure information requests reach the correct department
• Implement a document management system that enables rapid retrieval of medical records, clinical notes, and supporting documentation
• Set up automated alerts and follow-up reminders for pending payer information requests
• Train billing staff on the importance of timely, complete responses to payer information requests and the consequences of CARC 226 denials
• Conduct regular audits of payer correspondence to identify and address unanswered information requests before they result in denials
• Use electronic health record (EHR) systems with built-in capability to package and transmit requested clinical documentation directly to payers
• Verify that all initial claim submissions include complete supporting documentation to minimize the need for additional information requests

Also Filed As

The same CARC 226 may appear with different Group Codes:

Related Denial Codes