Information requested from the provider not received
The payer asked you for records or other information and did not get it, or got it too late.
CO = Contractual Obligation. The provider owes the difference. The patient cannot be billed for this amount. The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- Records request letter went to an old address or was missed.
- Records sent without the claim number or to the wrong fax.
- Response sent after the payer's deadline (often 30 or 45 days).
The fix
Find the request. Send the requested records with the claim number and the request reference, by the method the payer specified, and keep proof of delivery. Ask for reopening or reconsideration rather than a new claim.
Appeal or corrected claim?
Respond to the request (reopening or reconsideration). An appeal is needed only if the payer refuses to reopen.
Deadline to watch
The records request usually gives 30 to 45 days. The appeal window runs from the denial date.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-226 in short
What does CO-226 mean?
The payer asked you for records or other information and did not get it, or got it too late. The official X12 text reads: "Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)"
What usually causes a CO-226 denial?
Records request letter went to an old address or was missed. Records sent without the claim number or to the wrong fax. Response sent after the payer's deadline (often 30 or 45 days).
How do I fix CO-226?
Find the request. Send the requested records with the claim number and the request reference, by the method the payer specified, and keep proof of delivery. Ask for reopening or reconsideration rather than a new claim.
Should I appeal CO-226 or send a corrected claim?
Corrected claim. Respond to the request (reopening or reconsideration). An appeal is needed only if the payer refuses to reopen.
What deadline applies to CO-226?
The records request usually gives 30 to 45 days. The appeal window runs from the denial date.