CARC 226 Active

PR-226: Provider Information Not Provided or Insufficient

TL;DR

Patient charges for missing provider information are incorrect. Correct and request reprocessing.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
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 PR-226 Mean?

With PR (Patient Responsibility), the patient was assigned charges due to missing provider information. This is incorrect — missing provider data is a provider issue. Correct 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.

How to Resolve

  1. Correct the information Supply the missing data.
  2. Request reprocessing Resubmit and request patient charges be reversed.
Do Not Appeal This Code

Provider Information Not Provided or Insufficient grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

How to Prevent PR-226

Also Filed As

The same CARC 226 may appear with different Group Codes:

CO-226 OA-226

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/226
  3. 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
  4. Codes maintained by X12. Visit x12.org for official definitions.