CO 228 Denial Code - Resolve Missing Info Issues
Code 228 signals that a previous payer requested information needed to process the claim, but the necessary details were not provided by the provider, another provider, or the subscriber. This denial indicates that the claim cannot proceed until the missing information is supplied.
Who Pays: Group Code Liability
For code 228, the group code is most often CO, meaning the provider must write off the amount as a contractual obligation and cannot bill the patient. However, if the missing information is patient-related and the payer designates PR, then the patient can be billed.
Why Claims Get Code 228
- The provider did not submit required medical records to the initial payer.
- The subscriber failed to provide necessary insurance information to the previous payer.
- Another provider involved did not supply requested documentation.
- Coordination of benefits information was not relayed to the prior payer.
- The initial payer requested additional information which was not provided in a timely manner.
How to Fix & Resubmit
- Contact the previous payer to determine exactly what information is missing.
- Gather the requested documentation from your records or coordinate with the subscriber or other involved providers to obtain it.
- Submit the missing information directly to the previous payer as instructed.
- Verify with the previous payer that all necessary information has been received and that the claim will be reprocessed.
- Follow up with the current payer to confirm that the claim has been reconsidered and processed correctly.
Corrected Claim or Appeal?
For code 228, submitting the missing information to the previous payer is usually necessary. An appeal is not typically required unless there is a dispute about the information that was allegedly missing.
Preventing Future 228 Denials
- Ensure all required documentation accompanies initial claim submissions to avoid information requests.
- Implement a checklist for verifying that all payer-specific information requirements are met before submission.
- Regularly update coordination of benefits information to prevent missing data issues.
- Establish clear communication channels with patients to ensure they provide all necessary insurance information.