CO-227 denial code
Information requested from the patient was not provided
How to fix it
Contact the patient to prompt their response, then request reprocessing.
How to prevent it
Where a payer commonly requests patient information such as coordination of benefits updates, prompt patients proactively.
In practice
A payer writes to a patient asking whether they have other coverage. The letter goes unanswered, and every claim for that patient begins returning CO-227.
The plan needs information only the patient can give — usually a coordination of benefits update, an accident questionnaire or a student status confirmation — and it holds claims until the answer arrives.
Contacting the patient and explaining what is needed is usually all it takes, since most non-responses are inattention rather than refusal. Once they respond, the held claims reprocess without further action.
What sits behind it
Coordination of benefits questionnaires are the largest single source. Plans send them periodically to confirm whether other coverage exists, and patients routinely discard them as junk mail because they look like marketing rather than a condition of payment.
The consequence is invisible to the patient until claims start denying, at which point they may receive bills for care they believed was covered. Explaining that a form they ignored is holding their claims usually produces a fast response.
Because one unanswered request holds every claim for that patient, the effect compounds across providers. A practice noticing this pattern is often the first to tell the patient, and doing so resolves claims held at other practices too.
Related codes
Terms used here — Coordination of Benefits · Patient Responsibility · Denial
How we handle it — Patient Support · Denial Management · AR Management
Primary sources
The rules behind CO-227, at the bodies that publish them.
- Evaluation and Management services guide (opens in a new tab)
Centers for Medicare & Medicaid Services — How E/M level is determined under the current medical decision making and time rules. The reference for any dispute about whether documentation supports a level.
- Medicare Claims Processing Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — The operative manual for how Medicare claims must be coded, submitted, adjusted and appealed. When a payer policy and a vendor's advice disagree, this settles it.
- Medicare claims appeals process (opens in a new tab)
Centers for Medicare & Medicaid Services — The five levels of appeal, what each requires and the deadline for each. Missing a level's deadline ends the appeal regardless of the claim's merits.
Looking for a different code? Search all 190 CARC and RARC codes
Questions about CO-227
Coordination of benefits questionnaires confirming whether other coverage exists, accident questionnaires for injury-related claims, and student status confirmations for dependents. All three are conditions of payment and all three look like junk mail to the recipient.
Call and explain the connection. Most non-responses are inattention rather than refusal, and patients act quickly once they understand that a form they discarded is holding their claims and may lead to bills for covered care.
Yes — it typically holds every claim for that patient, across every provider. A practice that notices the pattern and contacts the patient often resolves claims sitting unpaid at other practices at the same time.
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