PR-228: Information Not Provided to Previous Payer
The patient did not respond to the primary payer's request for information. Help the patient provide the information, or bill the patient if they remain unresponsive.
What Does PR-228 Mean?
PR-228 indicates that the patient or subscriber was responsible for providing information to the previous payer (such as COB details, accident information, or other coverage data) and failed to do so. The patient is financially responsible for the claim until the information gap is resolved. The provider's role is to assist the patient in understanding what is needed and facilitating the response.
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.
Common Causes
| Cause | Frequency |
|---|---|
| Subscriber did not respond to primary payer The patient or insured did not respond to the primary payer's request for information (such as COB details, accident information, or other coverage details), preventing the primary payer from completing adjudication | Most Common |
| Patient did not provide accident or injury details to prior payer In cases involving injuries or accidents, the patient failed to provide the previous payer with details about the incident, other responsible parties, or other insurance coverage | Common |
How to Resolve
Identify the previous payer that needs information, supply the missing documentation, obtain their adjudication, then resubmit to the current payer.
- Explain the situation to the patient Contact the patient and explain that their primary insurance carrier requested information they did not provide, which is preventing all of their insurance claims from being processed.
- Help the patient respond Identify what information the primary payer needs and assist the patient in providing it. This may include COB details, accident information, or secondary insurance details.
- Request reprocessing or bill the patient If the patient provides the information and the primary payer reprocesses, resubmit to the current payer with the primary EOB. If the patient is unresponsive, release the claim to the patient for payment.
This adjustment is correct per the patient's benefit plan. The amount is the patient's financial responsibility. Collect from the patient rather than appealing.
Common RARC Pairings
The RARC code tells you exactly what triggered the PR-228:
| RARC | Description |
|---|---|
| N479 | Alert: Information requested from the provider/subscriber to a previous payer was not received. |
| N657 | Additional documentation must be submitted to the prior payer before this claim can be processed. |
How to Prevent PR-228
- Collect comprehensive COB and accident information from patients at registration before submitting claims
- Educate patients about the importance of responding to all correspondence from their primary insurance carrier
- Proactively contact patients when you learn their primary payer is requesting information
General Prevention
- Educate patients about the importance of responding to all correspondence from their insurance carriers
- Collect comprehensive COB and accident/injury information from patients at registration
- Proactively contact patients when you learn their primary payer is requesting information from them
- Provide patients with contact information for their primary payer's member services to facilitate response
Also Filed As
The same CARC 228 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/228
- https://x12.org/codes/claim-adjustment-reason-codes
- https://textexpander.com/blog/denial-codes-medical-billing-guide
- Codes maintained by X12. Visit x12.org for official definitions.