OA-226: Provider Information Not Provided or Incomplete

What Does OA-226 Mean?

OA-226 is uncommon and may appear when the information request involves coordination between multiple providers or payers. The provider still needs to respond to the request, but the adjustment is categorized as OA rather than CO due to the multi-party nature of the information gap.

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 Communication breakdowns are a leading root cause — the request may have been sent to an outdated address or fax number, received by the wrong department, or simply buried in the mail.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.

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. Determine the responsible provider Clarify whether the information request was directed at your practice or at another provider (referring, ordering, or rendering). If another provider was responsible, contact them to coordinate the response.
2. Coordinate and submit Work with the other provider to compile the requested information and submit it to the payer. Follow up to ensure the claim is reprocessed.

How to Prevent OA-226

• Establish communication protocols with referring and ordering providers for handling payer information requests
• Track claims where multiple providers are involved and monitor for information request denials

Also Filed As

The same CARC 226 may appear with different Group Codes:

Related Denial Codes