Denial Code 227: Information Requested From Patient Was Not Provided (Complete Guide)
When working on medical insurance claims, one common denial is:
Denial Code 227
“Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.”
This denial usually happens when the insurance company needs extra information from the patient, but the patient has not yet responded or the information provided is incomplete.
What is Denial Code 227?
Denial Code 227 means the payer is waiting for patient information such as:
• COB (Coordination of Benefits)
• Other insurance details
• Policy updates
• Member or dependent details
• Missing forms/documents
Until that information is received, the payer may mark the claim as:
• Denied
or
• Pending
Common Reason: COB Update Pending
What is COB?
COB = Coordination of Benefits
It is used to identify which insurance is:
• Primary insurance
• Secondary insurance
• Tertiary insurance
If COB is missing or incorrect, the payer cannot process the claim properly.
Why Does Denial Code 227 Occur?
Denial 227 occurs when:
✅ Insurance company requested information from the patient
❌ Patient did not respond
❌ Patient responded but information was incomplete
Usually, the payer sends a letter to the patient requesting the missing details.
Important Timeline (15–30 Days Rule)
Once the payer sends the letter, it may take time for the patient to update details.
Best Practice
• Allow 15 to 30 days after the payer letter date
• Do not bill the patient immediately
• Wait for the patient response
Call Handling Scenario for Denial 227 (Simple Steps)
When you call the payer, follow this step-by-step flow.
Step 1: Confirm Claim Status
Ask:
• “When did you receive this claim?”
• “May I get the denial date?” (if denied)
Step 2: Ask What Information Is Needed
Ask:
• “What information have you requested from the patient?”
Two possibilities:
- COB Update Needed
- Other Information Needed
Scenario A: COB Update Required
Ask if letter was sent:
“Have you sent a letter to the patient?”
If YES
Ask:
• “When did you send the letter?”
• “Have you received a response from the patient?”
✅ If response received
Ask:
• “Could you please reprocess the claim?”
• “What is the TAT for reprocessing?”
• Collect: Claim # + Call Ref #
❌ If response NOT received
Then:
• If letter sent but no response → claim can be released to patient
• Follow client instruction before billing patient
If NO letter sent
Ask:
• “May I get the claim # and call reference #?”
Then claim can be released to patient.
Scenario B: Other Information Required (Not COB)
Same flow applies.
Ask:
• “Have you sent the letter to the patient?”
• “When was it sent?”
• “Did you get patient response?”
If response received → request reprocessing + TAT
If not received → release claim depending on policy/client instructions
Key Notes and Actions for Denial 227
1. If letter sent + patient responded + payer agrees to reprocess
➡️ Set follow-up based on TAT provided by payer.
2. If letter sent but NO response from patient
➡️ Claim may be released to the patient (as per process/client SOP).
3. If letter date is less than 30 days
➡️ Do not bill patient yet
Give time for patient response.
4. If letter not sent
➡️ Claim can be released to patient
Collect claim number and call reference.
Extra Tip: Check Payment History Before Billing
If claim is denied/pending for COB update, check patient’s payment history.
If other insurance paid for nearby DOS (Date of Service), then:
✅ Verify eligibility of that insurance
✅ Confirm active coverage on DOS
✅ Bill claim to that insurance as primary
This can prevent unnecessary patient billing.
Conclusion
Denial Code 227 is not always a true denial — in most cases it means the payer is waiting for patient information (especially COB updates).
To handle it correctly:
• Confirm what information is missing
• Check if letter was sent
• Track dates (15–30 days)
• Request reprocessing if information received
• Follow client policy before billing patient
