OA-226: Provider Information Not Provided or Insufficient
Provider information is missing on the COB claim. Supply and resubmit.
What Does OA-226 Mean?
With OA (Other Adjustments), the missing provider information was flagged during coordination of benefits. Supply the information and resubmit.
CARC 226 indicates that the claim is missing essential provider information that the payer needs to process it. This is broader than NPI-specific denials (206, 207, 208) — it encompasses any provider data element that is missing or insufficient, including taxonomy codes, provider addresses, group practice information, specialty designations, or other required identifiers.
This denial typically results from incomplete provider setup in the billing system, changes in payer requirements for provider data elements, or errors in claim form completion. The fix is to identify what information is missing, supply it, and resubmit.
Common Causes
| Cause | Frequency |
|---|---|
| Information gap in coordination of benefits The secondary payer requested information from the provider that was not submitted or was incomplete | Common |
How to Resolve
- Supply the information Add the required provider data.
- Resubmit Submit the corrected claim.
Appeal with proof that the requested information was previously submitted, or submit the requested documentation with the appeal.
How to Prevent OA-226
- Verify provider information completeness for all payers
General Prevention
- Respond to all payer information requests including those from secondary payers
- Track information requests across all payers
Also Filed As
The same CARC 226 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.mdclarity.com/denial-code/226
- 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
- Codes maintained by X12. Visit x12.org for official definitions.