CO-227: Patient/Insured Information Not Provided

What Does CO-227 Mean?

CO-227 is uncommon but can occur when the payer holds the provider contractually responsible for collecting patient information that was not obtained during the intake process. In this scenario, the payer considers the information gap to be the provider's fault for not collecting it at registration rather than the patient's fault for not responding to the payer.

CARC 227 is a patient-information denial. The payer sent a letter or questionnaire to the patient (or insured/responsible party) requesting specific information — typically Coordination of Benefits (COB) details, secondary insurance information, or accident/injury-related data — and the patient did not respond or provided an incomplete answer. The payer cannot complete adjudication without this information, so the claim is held or denied.

This code almost always appears with Group Code PR because the patient caused the information gap. The payer typically sends the patient a COB questionnaire to determine whether other insurance coverage exists. If the patient does not respond within the allowed timeframe (usually 15-30 days), the payer denies the claim and assigns the financial responsibility to the patient. The denial essentially says: the patient was asked for information, did not provide it, and the payer cannot process the claim without it.

For the billing office, the resolution path depends on timing. If the payer's response deadline has not yet expired, hold the claim and do not bill the patient — the patient may still respond. If the deadline has passed and the payer confirms no response was received, contact the patient yourself to try to obtain the information. If you can get the information, submit it to the payer and request reprocessing. If the patient remains unresponsive, release the claim to the patient for payment.

Common Causes

How to Resolve

Determine whether the patient responded to the payer's request, assist the patient in providing the missing information if possible, or release the claim to the patient if the information cannot be obtained.

1. Identify the missing information Review the denial to determine what patient information the provider was expected to collect. Common items include COB details, secondary insurance, and current demographic data.
2. Collect from the patient Contact the patient to obtain the missing information. Update the patient's records in your practice management system.
3. Resubmit the claim Update the claim with the corrected patient information and resubmit to the payer. Include documentation showing the information has been obtained and verified.

How to Prevent CO-227

• Implement comprehensive intake procedures that capture all required insurance and COB information before services are rendered
• Use electronic eligibility verification tools that automatically detect missing or outdated patient information
• Train registration staff on the specific data elements payers require and the financial consequences of incomplete intake

General Prevention

• Implement comprehensive patient intake procedures that capture all required insurance and COB information before claim submission
• Verify and update patient demographics and insurance information at every visit using electronic eligibility tools
• Train registration staff on the specific information payers require and the consequences of incomplete patient data

Also Filed As

The same CARC 227 may appear with different Group Codes:

Related Denial Codes