CO-228: Information Not Provided to Previous Payer
A provider did not supply requested information to the primary payer. Identify the information gap, submit the documentation to the prior payer, then resubmit to the current payer with the prior EOB.
What Does CO-228 Mean?
CO-228 indicates that the provider (either your practice or another provider) was responsible for supplying the information to the previous payer and failed to do so. The current payer's denial is a contractual adjustment — you cannot bill the patient for a denial caused by the provider's failure to respond to a prior payer's information request. The resolution burden falls on the provider to fix the information gap with the previous payer.
CARC 228 is a multi-payer coordination denial. The current payer cannot process your claim because a previous payer in the billing sequence (typically the primary payer) was unable to complete its adjudication due to missing information. Someone in the chain — the billing provider, another provider involved in the patient's care, or the subscriber/patient — failed to respond to the previous payer's request for documentation, records, or other data needed for their review.
This code creates a chain reaction: the previous payer could not finish its work, which means the current payer has no primary EOB or ERA to reference, which means the current payer cannot determine its own payment responsibility. The entire billing sequence is stalled. The root cause is always an information gap with the previous payer, not the current one.
CARC 228 can appear with CO (the provider was responsible for supplying the information), PR (the patient was responsible), or OA (the situation involves complex multi-party coordination). The resolution path is the same regardless of group code: identify the previous payer, determine what information they need, supply it, wait for the previous payer to adjudicate, and then resubmit to the current payer with the prior payer's EOB/ERA.
Common Causes
| Cause | Frequency |
|---|---|
| Provider did not send records to primary payer The secondary or tertiary payer cannot process the claim because the billing or rendering provider failed to submit requested medical records or documentation to the primary payer, which needs this information to complete its adjudication | Most Common |
| Another provider did not furnish requested information A referring, ordering, or other provider involved in the patient's care did not supply information requested by a previous payer, and the current payer cannot proceed until the prior payer completes its review | Common |
| Previous payer's request went unanswered The previous payer sent one or more requests for additional information to the provider and never received a response, causing the previous payer to deny or hold the claim | Common |
| Incomplete initial claim submission to prior payer The original claim submitted to the previous payer lacked required supporting documentation, and the provider did not follow up with the missing information | Occasional |
How to Resolve
Identify the previous payer that needs information, supply the missing documentation, obtain their adjudication, then resubmit to the current payer.
- Identify the responsible provider Determine whether the information request was directed at your practice or at another provider (referring, ordering, or rendering). Check your records for any prior correspondence from the previous payer.
- Supply the missing information If your practice was responsible, gather the requested documentation and submit it to the previous payer immediately. If another provider was responsible, contact them and coordinate the submission.
- Obtain the prior payer's adjudication Once the previous payer processes the information, obtain their EOB/ERA. Monitor the timeline and follow up as needed.
- Resubmit to the current payer File the claim with the current payer, attaching the prior payer's completed EOB/ERA. The current payer can now determine their payment responsibility.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-228:
| RARC | Description |
|---|---|
| N479 | Alert: Information requested from the provider/subscriber to a previous payer was not received. |
| N657 | Additional documentation must be submitted to the prior payer before this claim can be processed. |
How to Prevent CO-228
- Respond promptly to all payer information requests, even from primary payers, to prevent downstream denials
- Track all payer correspondence with a workflow system that flags unanswered requests before they become denials
- Ensure initial claim submissions include comprehensive documentation to minimize additional requests from primary payers
- Verify primary payer adjudication is complete before submitting to secondary payers
General Prevention
- Establish clear communication protocols with all payers and respond promptly to every information request, even if the request seems duplicative
- Track all payer correspondence and information requests with a ticketing or workflow system to prevent requests from being missed
- Ensure initial claim submissions include comprehensive supporting documentation to minimize additional information requests from primary payers
- Coordinate with referring and ordering providers to ensure they respond to payer requests in a timely manner
- Verify the status of claims with the primary payer before submitting to secondary payers to ensure the primary has completed adjudication
- Maintain accurate contact information with all payers so information requests reach the correct department
Also Filed As
The same CARC 228 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/228
- https://x12.org/codes/claim-adjustment-reason-codes
- https://textexpander.com/blog/denial-codes-medical-billing-guide
- Codes maintained by X12. Visit x12.org for official definitions.