CO-226: Provider Information Not Provided Timely
Information requested from the billing/rendering provider was not provided or was not provided in a timely manner. The payer requested additional information from the provider but did not receive it within the required timeframe.
Why Claims Get Denied with CO-226
Denial code CO-226 is triggered when information requested from the billing/rendering provider was not provided or was not provided in a timely manner. the payer requested additional information from the provider but did not receive it within the required timeframe. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
Medical records requested by the payer were not submitted
Response to additional documentation request missed the deadline
Provider did not respond to payer's request for information
Requested records sent to wrong address or fax number
How to Appeal CO-226
If the information was submitted timely, provide proof of submission (fax confirmation, mail receipt, portal submission confirmation). If the information was not submitted, gather the requested documentation and submit it with your appeal. Note that many payers allow appeals even after missing the initial request deadline.
Documentation Required for Appeal
A successful appeal of CO-226 requires thorough documentation. Gather these items before drafting your appeal letter:
Proof of timely submission (fax confirmation, delivery receipt)
The requested information/documentation
Payer's original request letter with deadline
Appeal letter explaining any delay
How to Prevent CO-226 Denials
Implement a tracking system for payer information requests. Respond to all documentation requests within the stated timeframe. Confirm receipt of submitted documentation. Use electronic submission portals when available for trackable delivery.
Stop Fighting CO-226 Denials Manually
RediClaim generates payer-specific appeal letters for CO-226 denials in under 60 seconds, complete with the clinical arguments and documentation references that win reversals.