PR-227 Denial Code — Patient Information Not Provided (vs CO-226)

What PR-227 Means

PR-227 means the payer asked the patient for information and did not get it. The official X12 wording for code 227 is: “Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.” The PR part means the payer has put the unpaid amount on the patient.

Most of the time the claim itself is fine. The payer stopped because it sent the member a letter or form, and the answer came back late, empty or not at all. Once the missing information arrives, the claim is usually processed again. So treat PR-227 as a front-desk task, not a bill to send the patient.

What the Payer Usually Asked For

Code 227 always comes with at least one remark code, and that remark code tells you what is missing. The usual requests are:

Other insurance (coordination of benefits). The payer wants to know if another plan should pay first. Look for remark codes MA92 (“Missing plan information for other insurance”) or MA04 (the payer needs the primary payer’s details before it can pay as secondary).

Accident or injury details. An injury diagnosis can trigger a form asking whether auto, liability or workers’ compensation insurance should pay.

A general member request. Remark code N179 reads: “Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.”

Read the remark code before you call anyone. It is the difference between a two-minute fix and an afternoon on hold.

PR-227 vs CO-226: The Twin Codes

Codes 226 and 227 were created together, and people mix them up. Some billing websites even describe them backwards. The difference is who was asked:

	PR-227	CO-226
Official description	Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete	Information requested from the billing/rendering provider was not provided or not provided timely or was insufficient/incomplete
Who has to act	The patient (with the practice’s help)	The practice
Group code usually seen	PR — assigned to the patient	CO — contractual; cannot be billed to the patient
Typical cause	Unanswered other-insurance or accident questionnaire	Medical records or documentation the payer requested were not sent (remarks such as M127 or N706)
Usual fix	Patient updates the payer; claim reprocessed	Send the records; request reconsideration

If the remit shows 226, the patient has nothing to do and nothing to pay. The practice owes the payer an answer. If it shows 227, the practice still owns the follow-up, even though the payer has put the balance on the patient.

How to Fix a PR-227 Denial

Read the remark code and the payer letter. Identify exactly what was requested and when. Many payers show the request in their provider portal.

Contact the patient the same week. Explain that their insurer is holding the claim until they answer a question. Give them the member services number on their card. If they update their other-insurance details by phone, the hold often clears the same day.

Confirm the payer got the information, then ask how to get the claim processed again. Some payers do it automatically. Others need a reconsideration request or a corrected claim. If they want a resubmission, the claim frequency code tool tells you whether it is a 7 or an 8.

Watch the clock. A resubmitted claim is still subject to the payer’s timely filing limit. Run the dates through the TFL and AFL calculator before the window closes.

Bill the patient only as a last resort. PR means the payer has put the amount on the patient. But a patient who just forgot a form is usually covered again once they send it. Billing first and asking later is the fastest way to lose both the payment and the patient.

A Worked Example

A patient is seen for a 99214, and the claim comes back PR-227 with remark MA92. The payer’s records show a spouse’s work plan that may pay first, and nobody answered the letter it sent. The practice calls the patient. The patient says the spouse’s plan ended last year and updates it with member services. The practice checks with the payer and asks for the claim to be processed again. It pays as primary, with no patient bill and no appeal. If the spouse’s plan had still been active, the right move was to bill that plan first and send this one as secondary. The primary payer decision tool works out the order.

Prevention

Ask every patient about other coverage at check-in, and update it at least once a year, not just at the first visit.
For Medicare patients, complete the Medicare Secondary Payer questions, which capture employer coverage, accidents and workers’ compensation up front.
When an injury diagnosis is coded, record how and where the injury happened, so the payer’s accident questionnaire has an answer before it is sent.
Tell patients to watch for, and answer, coordination of benefits letters from their insurer. Many PR-227 denials start with an envelope nobody opened.

Sources

Reason code and remark code descriptions are quoted from the official X12 Claim Adjustment Reason Code and Remittance Advice Remark Code lists. Payers decide how they reprocess a claim once the information arrives, so follow the instructions on the remit or in the payer’s portal.

Related Denial Codes

CO-16 (claim lacks information), CO-22 (another payer may be primary), PR-1 (deductible), all denial codes, and our guide to billing secondary insurance.

Frequently Asked Questions

What does denial code PR-227 mean?

PR-227 means information the payer requested from the patient, insured or responsible party was not provided or was incomplete, and the payer has assigned the unpaid amount to the patient. The usual cause is an unanswered other-insurance or accident questionnaire.

What is the difference between CO-226 and PR-227?

Code 226 means the payer asked the billing or rendering provider for information and did not get it; it is usually a CO adjustment the patient cannot be billed for. Code 227 means the payer asked the patient; it is usually assigned to the patient as PR.

Can I bill the patient for a PR-227 denial?

The PR group code assigns the amount to the patient, but billing straight away is rarely the best move. Once the patient gives the payer the missing information, the claim can usually be reprocessed and paid, so contact the patient first and bill only if they will not respond.

Which remark codes come with PR-227?

Code 227 must be reported with at least one remark code. Common ones include MA92 (missing plan information for other insurance), MA04 (secondary payment needs the primary payer's information) and N179 (additional information has been requested from the member).

Do I need to resubmit the claim after a PR-227?

It depends on the payer. Some reprocess automatically once the patient responds, others need a reconsideration request or a corrected claim. If a resubmission is needed, the payer's timely filing limit still applies.

PR-227 — Information Requested From the Patient Was Not Provided