CARC 227 Active
OA-227: Patient/Insured Information Not Provided or Insufficient
TL;DR
Missing patient information flagged during COB. Supply and resubmit.
Action
Verify & Resubmit
Who Pays
Depends
Appeal
Yes
Patient Impact
Indirect
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues. What Does OA-227 Mean?
With OA, the missing patient information was flagged during coordination of benefits.
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 |
|---|---|
| COB information not provided in multi-payer scenario Information about other coverage was not provided by the patient, affecting COB determination | Common |
How to Resolve
- Supply the information Provide the missing patient data.
- Resubmit Submit the corrected claim.
Appeal Guide
Submit the coordination of benefits information and request claim reprocessing.
How to Prevent OA-227
- Verify patient information completeness for all payers
General Prevention
- Collect coordination of benefits information from patients at every visit
- Update COB information whenever patient coverage changes
Also Filed As
The same CARC 227 may appear with different Group Codes:
Related Denial Codes
OA-16 — Missing Information or Billing Error OA-146 — Diagnosis Invalid for Date of Service OA-148 — Information from Another Provider Not Provided or Incomplete OA-175 — Prescription Is Incomplete OA-181 — Procedure Code Invalid on Date of Service
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.