Denial Code PR-227
Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.
Source: X12 Claim Adjustment Reason Codes (CARC) & Group Codes. Maintained by the D3rx Clinical Billing Team.
What PR-227 means
The payer asked the patient (or insured/responsible party) for information — coordination of benefits, accident details, a questionnaire — and it wasn't provided or was incomplete. Until the patient responds, the balance can fall to them.
Why PR-227 happens
- The patient didn't return a coordination-of-benefits or accident questionnaire
- A required form or signature from the patient is missing
- The patient didn't respond to the payer's request for injury/other-coverage details
- Information the patient provided was incomplete or insufficient
What to do when you get PR-227
- 1Identify exactly what the payer asked the patient for (read the paired remark)
- 2Contact the patient and help them supply the information directly to the payer
- 3Submit the information on the patient's behalf where permitted, then request reprocessing
- 4Document outreach; the balance is the patient's while the request is outstanding
Got this denial right now?
Generate a patient-balance explainer letter — free
PR-227 is the patient's responsibility. Generate a clear, plain-English balance letter — free, no signup.
PR group code: who absorbs the charge
Patient Responsibility — May be billed to the patient.
A PR adjustment is the patient's liability — a deductible, coinsurance, copay, or a non-covered amount the patient owes. It is collectible directly from the patient, ideally after advance notice for any non-covered service.
Appeal, correct, or write off PR-227?
PR-227 resolves the moment the patient provides what the payer asked for — so the play is patient outreach plus a reprocessing request, not a formal appeal. The balance is the patient's responsibility until the information is supplied; make the ask easy (call, portal, prefilled form). Appeal only if the requested information was in fact provided and the payer overlooked it.
Timing & deadlines
Request reprocessing within the payer's timely-filing/reconsideration window once the patient responds (commonly ~90-180 days from the remittance commercial; Medicare 12 months from date of service for resubmission). There is no payer deadline on a legitimate PR balance, but resolve it quickly to keep the claim payable.
Example
A payer asks a patient to confirm whether an injury was work- or auto-related, and the patient doesn't respond. The claim posts PR-227. Reaching the patient, getting the questionnaire completed, and requesting reprocessing recovers payment.
Prevent PR-227 going forward
- Collect COB and accident/injury details at registration
- Have patients complete required payer forms up front
- Set up easy channels for patients to respond to payer information requests
- Follow up quickly when a payer requests information from the patient
Code families most affected
- Claims needing patient-supplied COB or accident information
- Services requiring a completed patient form/questionnaire
- Injury-related claims with potential other-party liability
Related codes
Payer notes
PR-227 concerns information requested from the PATIENT/insured (contrast CO-226, where the request was to the provider). The balance is the patient's while the request is unanswered, but the practical fix is helping the patient respond so the claim can be reprocessed.
Explain this PR-227 balance to your patient
PR-227 is a patient-responsibility balance. D3rx drafts a clear, plain-English patient-balance explainer for PR-227 — free, no signup.
Medical billing disclaimer
CARC/RARC definitions are the standardized X12 set; group-code semantics follow the X12 Claim Adjustment Group Code standard. Filing and appeal windows vary by payer — the standard anchors shown (Medicare redetermination 120 days from the remittance; Medicare timely filing 12 months from date of service; most commercial payers ~90-180 days) are general references, not a guarantee for any specific plan. Always confirm the rule in the payer's provider manual before acting. D3rx is not responsible for claim outcomes.