CARC 228 Active
OA-228: Denied for Failure to Supply Information to Previous Payer
TL;DR
The information gap is blocking COB processing. Supply the data to the previous payer.
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-228 Mean?
With OA, the information supply failure affected coordination of benefits processing.
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 |
|---|---|
| Information gap in multi-payer chain An information gap in the coordination of benefits chain caused the current payer to adjust the claim | Common |
How to Resolve
- Supply the information Respond to the previous payer's request.
- Process through COB Once resolved, process through the correct payer sequence.
Appeal Guide
Resolve the information gap with the previous payer and resubmit with updated coordination of benefits information.
How to Prevent OA-228
- Monitor and respond to all payer information requests across the COB chain
General Prevention
- Maintain visibility into the full COB claims chain for each patient
Also Filed As
The same CARC 228 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.