PR-227: Patient/Insured Information Not Provided

What Does PR-227 Mean?

PR-227 is the standard and most common pairing for this code. The patient or insured party is financially responsible because they failed to provide the information the payer requested. This is a common scenario when payers send COB questionnaires and patients ignore them — the payer cannot determine if other coverage exists, so they deny the claim and shift responsibility to the patient until the information gap is resolved.

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. Verify the payer's timeline Call the payer to confirm when the patient letter was sent and whether the response deadline has passed. If the patient has already responded, request immediate reprocessing.
2. Reach out to the patient Contact the patient by phone, then by mail if needed. Explain that their insurance needs specific information before they can pay the claim. Be specific about what is needed — COB details, secondary insurance information, or other data.
3. Assist with the response If possible, help the patient complete and submit their response to the payer. Some payers accept COB information directly from the provider with the patient's authorization.
4. Bill the patient if unresolved After reasonable attempts to reach the patient (at least two contacts over 30 days), transfer the balance to the patient's account. Include a clear explanation of why they owe and how they can still resolve it by contacting their insurer.

Common RARC Pairings

The RARC code tells you exactly what triggered the PR-227:

How to Prevent PR-227

• Collect complete COB information from every patient at registration — ask specifically about other insurance coverage, Medicare, Medicaid, and workers compensation
• Update COB information at every visit and document the patient's response even if they report no changes
• Educate patients during check-in about the importance of responding to all insurance company correspondence
• Implement patient portals or automated reminders that prompt patients to update their insurance information
• Monitor claims for COB-pending status and proactively contact patients before the payer's deadline expires

General Prevention

• Collect complete Coordination of Benefits (COB) information from every patient at registration and update it at each visit
• Ask patients directly whether they have additional insurance coverage and document their response
• Implement online patient portals that allow patients to update their insurance information and respond to COB questionnaires electronically
• Maintain current patient contact information (phone, email, address) so payers can reach patients when information is needed
• Educate patients at check-in about the importance of responding to payer correspondence, especially COB questionnaires
• Set up automated patient communication (text, email) to remind patients to respond to payer information requests
• Monitor claim status for pending COB responses and proactively contact patients before the deadline expires

Also Filed As

The same CARC 227 may appear with different Group Codes:

Related Denial Codes