What CO-226 means
The payer asked for information (such as records) and did not receive it in time or in full.
The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.
Common causes
- Records request missed or answered late
How to fix it
- Send the requested information and ask for reprocessing
- Track payer requests with deadlines
Check the remark code (RARC) that came with the denial and the payer's own policy, since rules vary by payer and plan. This is a plain-English summary written by GetMax; the official code text is published by X12 at x12.org/codes.
Prevent it next time
Most denials are caused before the claim is sent. See 12 ways to reduce claim denials, or let our denial management team work them for you.