CO-227: Requested information from the patient not supplied

What causes CO-227?

• Coordination of benefits questionnaire sent to the patient and not returned
• Accident or injury details requested and not supplied
• Student or dependent status verification outstanding
• Payer wrote to an old address

How do you fix a CO-227 denial?

1. Ring the payer and find out exactly what was asked of the patient and how they can supply it.
2. Contact the patient and tell them specifically what to do — most of these sit unanswered because the payer’s letter was not understood.
3. Many payers will accept the information over the phone from the patient, which is far faster than post.
4. Resubmit or ask for reprocessing once the payer confirms it has what it needs.

Can CO-227 be prevented?

Ask about other coverage and about accident-related care at registration. A coordination of benefits question answered on day one never becomes this denial.

A denial like this one is the recurring cost that medical billing outsourcing is built to take off your desk — a dedicated seat working the queue instead of it waiting for whoever has a free hour.

Codes worked the same way

CO-227 is answered with the document the payer names. So are these, which is why a queue sorted by recovery route moves faster than one sorted by code number — the same person, in the same system, with the same evidence to hand, clears all of them in one pass.

• CO-252 — Additional documentation required
• CO-226 — Requested information not supplied
• CO-251 — Documentation incomplete
• N29 — Documentation missing

Specialties that name this among their costliest

These are specialties whose own worst denials include one of this kind. The line under each is the denial they name, quoted from their page so you can see what the link is based on.

• Anesthesia
  Time units miscalculated from an incomplete anesthesia record
• Ophthalmology
  Intravitreal injection paid for the administration but not the drug, because the units given and the amount discarded were never written into the note.
• Otolaryngology
  Endoscopic sinus surgery denied because the chart never pulls the failed medical management together — the drug trials, their dates and imaging findings sit in separate notes or nowhere.
• Neurology
  Nerve conduction study with needle EMG denied because the report gives only a summary impression instead of each nerve and muscle tested with its findings
• Obstetrics & Gynecology
  Global maternity package billed in full after the patient transferred care mid-pregnancy, when only the antepartum visits actually rendered here should have been itemised.
• Urgent Care
  Laceration repair paid at the simplest level because the note says the wound was closed but never records its length, its site or whether the closure was layered

What leaving it costs

Working a denied claim costs $57.23 per denied claim in administrative time (source) — before any of it is recovered, and whether or not it ever is.

Payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment (source), so the reason one sits is rarely that nobody knows how to work it. Put your own denial count in.

Questions

Code descriptions are the standard X12 claim adjustment reason and remittance advice remark code text. Payer policies differ, and the payer’s own coverage policy governs any individual claim. This page is working guidance, not legal or clinical advice.