CO-227: Patient/Insured Information Not Provided or Insufficient
Supply the missing patient information and resubmit. Do not appeal.
What Does CO-227 Mean?
With CO, the missing patient information is the provider's billing responsibility. Supply the data and resubmit.
CARC 227 indicates the claim is missing essential patient or subscriber information that the payer requires for processing. This includes demographic data, subscriber identification, relationship to the insured, date of birth, address, or other patient-specific data elements. Without complete patient information, the payer cannot identify the patient in their system or verify benefits.
Common Causes
| Cause | Frequency |
|---|---|
| Patient did not respond to payer's information request The payer sent a request for information directly to the patient or insured party and did not receive a response within the required timeframe | Most Common |
| Accident or injury details not provided by patient The payer requested details about how an injury occurred (e.g., auto accident, workplace injury) and the patient did not provide the information | Common |
| Coordination of benefits information not provided The payer requested information about other insurance coverage and the patient did not respond | Common |
| Incomplete patient questionnaire The patient was sent a questionnaire about their condition or coverage and either did not return it or returned it with incomplete information | Common |
How to Resolve
- Identify and supply the missing data Determine what is needed and provide it.
- Resubmit Submit the corrected claim.
Appeal once the patient has provided the requested information. Include the requested documentation and evidence of when the patient provided the information. If the payer's original request was not received by the patient, include evidence such as address discrepancies.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-227:
| RARC | Description |
|---|---|
| N479 | Missing/incomplete/invalid information. Work with the patient to provide the specific missing information to the payer → |
| MA130 | Your claim contains incomplete and/or invalid information, and no appeal rights are afforded. Obtain the requested information from the patient and resubmit → |
How to Prevent CO-227
- Collect complete patient demographic and insurance information during registration
- Verify patient information at every visit
- Implement claim scrubbing to catch missing patient data before submission
General Prevention
- Assist patients in responding to payer information requests by providing guidance at the time of service
- Collect accident and injury details during patient registration to have on file if requested
- Help patients complete payer questionnaires during office visits
- Maintain up-to-date patient contact information to facilitate payer communication
- Follow up with patients when you become aware of pending payer information requests
Also Filed As
The same CARC 227 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- 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
- https://www.aapc.com/resources/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.