PR-227: Patient/Insured Information Not Provided or Insufficient
The patient's information was not provided. Obtain it and resubmit before collecting from the patient.
What Does PR-227 Mean?
With PR, the patient is responsible because their information was not provided. This may occur when the patient did not supply required information.
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 |
|---|---|
| Patient failed to provide requested information The patient was directly responsible for providing information to the payer and failed to do so, resulting in the patient bearing financial responsibility | Most Common |
How to Resolve
- Contact the patient Request the missing information.
- Resubmit if obtained If the patient provides the information, resubmit the claim.
If the patient subsequently provides the requested information, submit it to the payer and request claim reprocessing.
How to Prevent PR-227
- Collect complete patient information at registration
- Follow up with patients who provide incomplete information
General Prevention
- Educate patients about the importance of responding to payer information requests promptly
- Provide patients with payer contact information for responding to requests
Also Filed As
The same CARC 227 may appear with different Group Codes:
Related Denial Codes
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.