CO-226 denial code
The payer asked the provider for information and didn't receive it, didn't receive it in time, or found it incomplete.
“Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. …”
Start 09/21/2008 · Last modified 07/01/2013 · X12 adjustment reason code list
What it usually means in behavioral health
CO-226 is what an unanswered records request turns into. Behavioral health programs are seeing more of them through prepayment review, targeted probes, and post-payment audits, and the letters often land in a general mailbox or the wrong department.
Common causes
- Records request never reached the right person
- Response sent after the payer's deadline
- Response missing the documents the request listed
- Response sent to the wrong address or portal
Correct and resubmit, or appeal?
If the records were sent on time, appeal with proof of delivery. If not, check whether the payer will still accept them; some reopen the claim when the records arrive, others require an appeal with the records attached.
What to do
Find the original request and its deadline.
Send the complete, indexed records, or proof they were already sent.
Route every payer records request to one owner with a tracked deadline.
Often seen with
- M127
- N517
Got a CO-226 on your desk?
Send us the facts on that one denial — codes, payer, level of care, and dollar amount, no patient information — and within 2 business days we’ll tell you whether to correct or appeal, the deadline to watch, and what evidence would answer it. Free.