PR-228: Denied for Failure to Supply Information to Previous Payer
Resolve the information request with the previous payer before collecting from the patient.
What Does PR-228 Mean?
With PR, the patient may be responsible because information was not supplied. Contact the previous payer first before billing the patient.
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 |
|---|---|
| Subscriber failed to provide information to previous payer The patient/subscriber did not respond to the previous payer's information request, causing the current payer to deny the claim | Common |
How to Resolve
- Resolve the information request Supply the requested information to the previous payer.
- Collect if unresolvable If the information cannot be supplied, collect from the patient.
Once the patient provides the requested information to the previous payer, request claim reprocessing with the updated previous payer EOB.
How to Prevent PR-228
- Respond to all payer information requests to prevent patient charges
General Prevention
- Educate patients about the importance of responding to all payer information requests
- Help patients understand the multi-payer claims process and their role in it
Also Filed As
The same CARC 228 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.