CO227 denial code description and corrective action

Information requested from patient/insured/responsible party was not provided or was insufficient/incomplete.

This denial is related to information requested from the patient, such as Coordination of Benefits (COB) or other required details.
It mostly occurs when the requested information is not provided.
When the insurance requests information from the patient, they send a letter to the patient regarding that information.
If the provided information is not sufficient to meet the insurance requirements, it can also cause this denial.

First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.
Call the insurance company and discuss the denial. If it is confirmed that all the required information has already been received, ask the representative to reprocess the claim. Be sure to record the claim number, representative’s name, and call reference number, and then follow up on the claim after the given TAT.
If COB or other information is required from the patient and a letter has already been sent recently, then we will wait up to 15 to 30 days for the patient’s response.
If the insurance has sent a letter and 30 or more days have passed, then bill the claim to the patient or contact the client for further instructions.
If the insurance has not yet sent a letter, then we should ask the representative to send one for the required information and also try to contact the member directly to tell member to update the specific information with the insurance.
If the requested information is COB, click here for further details.