PR-227 Denial Code: Information Requested from the Patient Was Not Provided

PR-227 is Claim Adjustment Reason Code 227 with group code PR. CARC 227 means information requested from the patient, insured, or responsible party was not provided or was insufficient/incomplete. CO-227 means the same CARC with group code CO. Search demand often uses “denial code pr 227,” so this page uses slug pr-227 while covering both group codes. (Primary sources: X12 Claim Adjustment Reason Codes · CMS Medicare Claims Processing Manual, Ch. 22, §60.1)

Quick answer: Open the remark code. It names what the payer still needs from the patient (questionnaire, accident details, other-insurance form, signature, COB statement). Get that item from the patient or insured, then resubmit or appeal with the attachment. Do not treat 227 like CO-226 (provider-side missing info). If group code is PR and the patient will not respond, document outreach and follow your financial policy.

Part of our denial codes library. Written by Manikandan, a revenue cycle management specialist with more than 10 years of US medical billing experience. Last reviewed: 11 October 2026. Official code wording is quoted word for word from X12; Medicare rules link to their CMS or Medicare contractor source.

PR-227 / CO-227 denial code description (official X12 wording)

X12 Claim Adjustment Reason Code 227, verbatim:

“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.)”

Source: X12 Claim Adjustment Reason Codes, checked 11 October 2026. Start: 09/21/2008 | Last Modified: 09/20/2009.

The CARC is 227. Payers attach group code PR or CO (occasionally OA/PI on non-Medicare remits) depending on who they assign for leftover dollars. X12 requires at least one remark code that is not an ALERT.

What PR-227 and CO-227 mean in plain English

• CARC 227 means the payer asked the patient, insured, or responsible party for information and did not get enough to finish adjudication.
• PR-227 — payer assigns the adjusted amount as patient responsibility (common when the patient must return a form and has not).
• CO-227 — payer assigns the amount as a contractual/provider adjustment (less common; still requires the remark and still needs the missing patient item to reprocess).

Always trust the group code on the remit. Always open the remark code — 227 alone does not say which patient document is missing.

PR-227 vs CO-226, CO-16, CO-252 and CO-31

Code	Official X12 text (short)	Difference
227	Info requested from patient/insured/responsible party not provided or incomplete (remark required)	Patient-side missing info
226	Info requested from Billing/Rendering Provider not provided, not timely, or incomplete (remark required)	Provider-side missing info
16	Claim/service lacks information or has submission/billing error(s) (remark required)	Generic missing/invalid claim data — see CO-16
252	An attachment/other documentation is required to adjudicate this claim/service (remark required)	Attachment missing — see CO-252
31	Patient cannot be identified as our insured	Identity/eligibility match — see CO-31

227 = patient must supply something. 226 = your office must supply something. Mixing them up sends the wrong outreach letter.

Group code matrix for CARC 227

Group + 227	Who carries the amount	Typical next step
PR-227	Patient	Request the item from patient; bill only after policy allows if they never respond
CO-227	Provider	Still obtain the patient item to reprocess; write off only if contract says so and reprocess fails
OA-227	Neither fits cleanly	Read remarks; rare
PI-227	Payer-initiated	Non-Medicare; investigate contract

CMS Ch. 22 §60.1: PR amounts “may be billed to the patient or insured”; CO amounts are generally provider write-offs not billed to the patient.

Remark codes that help with CARC 227

RARC	Role
N4	Missing/incomplete/invalid prior insurance carrier(s) EOB
MA92	Missing plan information for other insurance
N30	Patient ineligible for this service (context may differ)
N382	Missing/incomplete/invalid patient identifier
M51 / MA130	Wrong pairing for pure patient-doc gaps — see M51 / MA130 if the remark points there

The remark is the work order. If the remit has no usable remark, call the payer and ask which patient form or data element is outstanding.

Where PR-227 / CO-227 shows up in the 835

SVC*HC:99213*185.00*0.00~
CAS*PR*227*185.00~
LQ*HE*MA92~

• Office visit held because other-insurance / COB plan information from the patient was incomplete.
• Group PR → patient responsibility until the item is supplied and the claim is reprocessed.

Illustrative only.

How to fix PR-227 / CO-227: decision path

1. Read group code + every remark code. Confirm it is 227 (patient), not 226 (provider).
2. Name the missing item. Questionnaire, accident statement, other-payer form, signature on file gap, student status, Medicare Secondary Payer questionnaire, etc.
3. Contact the patient/insured with a clear checklist and deadline. Document calls and portal messages.
4. Collect and attach the item (PWK / portal / mail per payer rules). For pure claim-data fixes after the patient responds, use a corrected claim when allowed.
5. Resubmit or appeal with the remark answered. Reference the original claim number.
6. If the patient never responds and group is PR — follow your financial policy; do not invent clinical data.
7. If group is CO — do not balance-bill unless a valid notice shifts liability; keep trying to reprocess with the missing item.
8. Prevent — collect COB, accident, and MSP forms at registration before the claim drops.

Medicare and commercial notes

Medicare. MSP and other-insurance questionnaires often drive patient-information holds. Match the code you received; MACs may also use CO-16 plus a remark when the claim is unprocessable. Unprocessable claims generally have no appeal rights — correct and resubmit within timely filing (CMS Ch. 1 patterns; confirm current chapter text).

Commercial. “denial code pr 227” is common vernacular when the member must return a coordination-of-benefits or accident form. Employer plans vary on how long they pend versus deny.

Versus CO-226. Train staff: patient letters for 227, provider documentation requests for 226. See also our CARC & RARC guide.

Worked example (illustrative)

For example, a commercial primary returns PR-227 with MA92 after an ER visit. Group code PR. The patient has coverage through a spouse that was not disclosed at registration.

Reading it: patient-side other-insurance information incomplete; patient liable on the remit until fixed.

Fix: send the patient the payer’s other-insurance form; once returned, attach and ask for reprocessing (or corrected claim per payer). Update registration so the next claim carries the secondary.

Prevention: MSP / other-insurance attestation at check-in; eligibility workqueue flags for “other coverage” responses.

PR-227 / CO-227 appeal or patient-notice template

[Date]
[Payer] Appeals / Provider Service
[Address, fax or portal]

Re: CARC 227 (patient/insured information) — [reprocess / corrected claim]
Patient: [Name]   Member ID: [ID]   DOB: [MM/DD/YYYY]
Claim number: [Claim #]   Date(s) of service: [MM/DD/YYYY]
CPT/HCPCS: [Code]   Group code on remit: [PR / CO]

The remittance shows CAS*[PR/CO]*227 with remark [code]. Please reprocess
because the requested patient/insured information is now enclosed:
[ ] Other insurance / COB form dated [date]
[ ] Accident / injury statement
[ ] [Other item named on remark]

Enclosed: remit, claim, patient-completed form(s), outreach log.

[Name, credentials]  [Practice, NPI]  [Phone / email]

Patient outreach notice:

Your payer needs information from you before this claim can finish
processing (CARC 227 / remark [code]) for DOS [date]. Please complete
the enclosed form and return it by [date]. Without it, the claim may
remain unpaid and you may receive a balance statement.

Prevention checklist

• Collect other-insurance / MSP forms at registration.
• Capture accident and work-related questions when the visit type needs them.
• Separate 227 (patient) queues from 226 (provider) queues.
• Always open the remark before calling the payer.
• Document patient outreach dates before billing PR balances.
• Do not confuse 227 with CO-31 identity failures or CO-252 attachment requests aimed at the provider.
• Train staff with the CARC & RARC guide.

Related denial codes

• CO-16: missing/invalid claim information (generic).
• CO-252: attachment required.
• CO-31: patient not identified as insured.
• MA130: unprocessable / incomplete claim messaging patterns.
• N290: rendering provider identifier issues (provider-side).
• CARC & RARC guide.

In short

CARC 227 means the patient or insured still owes the payer a piece of information. Read the remark, collect that item, resubmit, and keep PR vs CO straight when you statement the account.

FAQ

Quick facts

Item	Value
X12 code	227
X12 start	09/21/2008
Last modified	09/20/2009
Slug	pr-227 (covers PR-227 and CO-227)
Last reviewed	11 October 2026
Page type	WordPress Page under Denial Codes hub 183
Primary keyword	denial code pr 227

Sources

• X12, Claim Adjustment Reason Codes (CARC 227, 226, 16, 252, 31). CARC 227 Start 09/21/2008, Last Modified 09/20/2009. Accessed 11 Oct 2026.
• X12, Remittance Advice Remark Codes. Accessed 11 Oct 2026.
• CMS, Medicare Claims Processing Manual (IOM 100-04), Ch. 22, §60.1 Group Codes
• CMS, Medicare Claims Processing Manual, Ch. 1 (timely filing / unprocessable patterns)

Access dates and figures on this page were checked on 11 October 2026 against X12 and CMS sources.

Last reviewed: 11 October 2026 · This page is educational and doesn’t replace payer-specific instructions.