CO-228: Denied for Failure to Supply Information to Previous Payer
Supply the information requested by the previous payer to unblock claim processing.
What Does CO-228 Mean?
With CO, the failure to supply information is the provider's responsibility. Contact the previous payer, supply the requested data, and resolve the claim.
CARC 228 indicates that a previous payer (typically the primary payer) requested additional information from the provider, and the provider did not respond. Because the primary payer could not complete processing without this information, the secondary payer also cannot process the claim. This creates a chain reaction where missing information blocks the entire COB process.
Common Causes
| Cause | Frequency |
|---|---|
| Provider did not supply information to the primary payer The current payer denied the claim because a provider (this one or another) failed to provide requested information to a previous payer in the claims chain | Most Common |
| Primary payer adjudication delayed due to missing information The previous payer could not adjudicate their portion because information was not provided, causing the secondary payer to deny | Common |
| Another provider failed to respond to prior payer A different provider in the treatment chain did not supply information requested by a prior payer, affecting this claim's adjudication downstream | Common |
How to Resolve
- Contact the previous payer Determine what was requested.
- Supply the information Provide the requested data.
- Follow the COB sequence Process through primary first, then secondary.
Supply the missing information to the previous payer and allow them to adjudicate their portion. Then appeal this denial with the updated EOB from the previous payer showing the resolved claim.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-228:
| RARC | Description |
|---|---|
| MA130 | Your claim contains incomplete and/or invalid information, and no appeal rights are afforded. Submit the missing information to the previous payer and resubmit once resolved → |
How to Prevent CO-228
- Respond promptly to all payer requests for additional information
- Track open information requests and their deadlines
- Implement a system to flag and follow up on pending payer inquiries
General Prevention
- Respond promptly to all information requests from all payers, not just the primary payer
- Track coordination of benefits claims and ensure all payers in the chain have the information they need
- Coordinate with other providers involved in the patient's care to ensure they respond to payer requests
- Maintain complete documentation to quickly fulfill information requests from any payer
Also Filed As
The same CARC 228 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.