226Denial Code (CARC)Active
CO 226 Denial Code - Info Request Fix & Prevention
Code 226 indicates that the payer requested additional information from the billing or rendering provider, but it was either not submitted, submitted late, or was incomplete. This denial means the claim is being held up until the necessary documentation is provided to the payer.
Who Pays: Group Code Liability
For code 226, the group code is typically CO, meaning the provider must resolve the issue and cannot bill the patient. It is a contractual write-off situation until the claim is properly addressed.
Why Claims Get Code 226
- Provider failed to send requested documentation in time.
- Submitted documentation was incomplete or insufficient.
- Payer requested additional information but provider did not receive the request.
- Documentation was sent but not matched to the claim by the payer.
- Provider misunderstood the specific documentation requested.
How to Fix & Resubmit
- Verify what specific information the payer requested by checking the accompanying remark code.
- Ensure the requested documentation is complete and matches the payer's specifications.
- Resubmit the necessary documentation to the payer promptly.
- Contact the payer to confirm receipt and that the documentation fulfills the request.
- If the documentation was originally sent but not received, provide proof of submission to the payer.
Corrected Claim or Appeal?
For code 226, submit a corrected claim with the complete documentation as requested. An appeal is not typically necessary unless the payer disputes the completeness of the resubmitted information.
Preventing Future 226 Denials
- Implement a tracking system for all documentation requests from payers to ensure timely responses.
- Train staff on identifying and responding to payer requests for additional information.
- Establish a checklist for required documentation to prevent incomplete submissions.
- Use certified mail or electronic confirmation when sending documentation to ensure receipt.