227Denial Code (CARC)Active
PR 227 Denial Code - Resolve Patient Info Issues
Code 227 indicates that the payer needed more information from the patient or insured party to process the claim. This information was either not provided or what was provided was incomplete. The accompanying remark code will specify exactly what information is missing or insufficient.
Who Pays: Group Code Liability
Typically, code 227 will appear with group code PR, meaning the patient is responsible for providing the missing information. The provider can bill the patient for the amount until the required information is submitted.
Why Claims Get Code 227
- The patient did not respond to a request for additional information from the insurer.
- The information provided by the patient was incomplete or incorrect.
- The insurer requested coordination of benefits information, and it was not supplied.
- A questionnaire or form required by the insurer was not completed by the patient.
- The claim was missing necessary documentation from the patient, such as proof of coverage.
How to Fix & Resubmit
- Review the accompanying remark code to identify the specific information needed.
- Contact the patient to obtain the missing or incomplete information.
- Ensure all provided information is accurate and complete before resubmission.
- Submit the corrected information to the payer as instructed in the remark code.
- Follow up with the payer to confirm that the claim is now being processed.
Corrected Claim or Appeal?
For code 227, a corrected claim is necessary once the patient provides the required information. An appeal is not typically applicable unless you believe the information request was erroneous.
Preventing Future 227 Denials
- Ensure patient information is complete and accurate at registration.
- Educate patients on the importance of responding promptly to insurer information requests.
- Verify that all required patient documentation accompanies claims before submission.
- Implement a system to track payer requests for additional information and follow up with patients.