OA-228: Information Not Provided to Previous Payer

What Does OA-228 Mean?

OA-228 appears in complex multi-provider, multi-payer coordination scenarios where the information gap does not fall clearly on the provider or the patient. The adjustment reflects a systemic coordination breakdown rather than a single party's failure to respond.

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.

How to Resolve

Identify the previous payer that needs information, supply the missing documentation, obtain their adjudication, then resubmit to the current payer.

1. Map the full coordination chain Identify all providers and payers involved in the claim. Determine which payer issued the original information request and which party was expected to respond.
2. Coordinate the response Work with all involved parties to compile and submit the missing information to the previous payer. Track the submission and follow up on adjudication status.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-228:

How to Prevent OA-228

• Establish clear communication protocols among all providers involved in a patient's care for handling payer requests
• Implement tracking systems that flag multi-payer claims requiring coordination

Also Filed As

The same CARC 228 may appear with different Group Codes:

Related Denial Codes