Information requested from the patient not received
The payer asked the patient for information (accident details, other insurance, student status, a questionnaire) and the patient did not answer.
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
- Coordination of benefits questionnaire not returned.
- Accident or injury questionnaire not returned.
- Dependent eligibility proof not supplied.
The fix
Call the patient, explain what the payer needs, and help them respond (many payers accept it by phone). Then ask the payer to reprocess the claim.
Appeal or corrected claim?
Not an appeal. The patient must respond; then request reprocessing. Some payers allow billing the patient if they never respond.
Deadline to watch
Payer usually allows 30 to 60 days; the claim stays denied until the patient responds.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-227 in short
What does CO-227 mean?
The payer asked the patient for information (accident details, other insurance, student status, a questionnaire) and the patient did not answer. The official X12 text reads: "Information requested from the patient/insured/responsible party was not provided 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-227 denial?
Coordination of benefits questionnaire not returned. Accident or injury questionnaire not returned. Dependent eligibility proof not supplied.
How do I fix CO-227?
Call the patient, explain what the payer needs, and help them respond (many payers accept it by phone). Then ask the payer to reprocess the claim.
Should I appeal CO-227 or send a corrected claim?
Call or redirect. Not an appeal. The patient must respond; then request reprocessing. Some payers allow billing the patient if they never respond.
What deadline applies to CO-227?
Payer usually allows 30 to 60 days; the claim stays denied until the patient responds.