DENIAL CODE · CO-226

CO-226: Requested Provider Information Not Provided

CO-226 means the payer asked the provider for information — records, an itemized bill, a questionnaire — and didn't get it, or got an incomplete response, so it denied the claim.

Official (X12/WPC): "Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete."

Why payers issue CO-226

  • A records or documentation request wasn't received or was missed
  • The response was sent but incomplete or to the wrong place
  • The request went to an old address or fax and never surfaced
  • The deadline to respond passed before anyone saw it

Is it recoverable? Recoverable when you still hold the records and the appeal window is open — the danger is the clock, not the merits. Respond with the complete documentation.

How to appeal a Missing or Invalid Information denial →

Common questions

What does CO-226 mean?

CO-226 means the payer asked the provider for information — records, an itemized bill, a questionnaire — and didn't get it, or got an incomplete response, so it denied the claim. Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete.

How do I appeal or fix a CO-226 denial?

Recoverable when you still hold the records and the appeal window is open — the danger is the clock, not the merits. Respond with the complete documentation. Common causes: a records or documentation request wasn't received or was missed; the response was sent but incomplete or to the wrong place; the request went to an old address or fax and never surfaced; the deadline to respond passed before anyone saw it.

Is a CO-226 denial worth appealing?

Recoverable when you still hold the records and the appeal window is open — the danger is the clock, not the merits. Respond with the complete documentation. You only pay on what's actually recovered, so there's no cost to working the ones that are winnable.

Other denial codes
CO-197 · Precertification / Authorization Absent →CO-50 · Not Medically Necessary →CO-16 · Missing or Invalid Information →CO-45 · Charge Exceeds Fee Schedule →CO-97 · Bundled into Another Service →CO-29 · Timely Filing Expired →CO-96 · Non-Covered Charge →OA-18 · Duplicate Claim →OA-22 · Coordination of Benefits →CO-11 · Diagnosis Inconsistent with Procedure →CO-151 · Too Many Services (Frequency/MUE) →CO-B7 · Provider Not Eligible →CO-27 · Coverage Terminated →CO-204 · Not Covered Under Current Plan →CO-109 · Not Covered by This Payer →CO-119 · Benefit Maximum Reached →CO-4 · Modifier Inconsistent or Missing →CO-15 · Authorization Number Missing or Invalid →OA-23 · Prior Payer Adjudication Impact →CO-24 · Charges Covered Under Capitation →CO-26 · Expenses Incurred Prior to Coverage →CO-54 · Assistant Surgeon Not Covered →CO-55 · Experimental / Investigational →CO-58 · Inappropriate Place of Service →CO-59 · Multiple/Concurrent Procedure Reduction →CO-107 · Related/Qualifying Claim Not Identified →CO-167 · Diagnosis Not Covered →CO-170 · Denied for This Provider Type →CO-181 · Procedure Code Invalid on Date of Service →CO-182 · Procedure Modifier Invalid on Date of Service →CO-183 · Referring Provider Not Eligible to Refer →CO-185 · Rendering Provider Not Eligible →CO-198 · Precertification / Authorization Exceeded →CO-231 · Mutually Exclusive Procedures →CO-234 · Procedure Not Paid Separately →CO-236 · Procedure/Modifier Combination Not Compatible →CO-242 · Out-of-Network / Non-Network Provider →CO-252 · Documentation Required to Adjudicate →CO-253 · Sequestration Reduction →CO-256 · Not Payable Per Managed-Care Contract →CO-288 · Referral Absent →CO-B15 · Qualifying Service Not Received →CO-B16 · New Patient Qualifications Not Met →CO-A1 · Claim/Service Denied (Remark Required) →

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