CARC 228 — A prior payer's claim wasn't fully adjudicated because requested information wa

CARC 228PR · Patient Responsibility

A prior payer's claim wasn't fully adjudicated because requested information was never supplied, which is now affecting this claim.

Common causes: A coordination-of-benefits information request from the primary payer was never completed.
Suggested fix: Complete the outstanding information request with the primary payer, then resubmit to this payer with the primary's finalized EOB.

Related Patient Responsibility codes

1The billed amount was applied to the patient's plan deductible instead of being paid by the payer.119The patient has used up the maximum benefit allowed for this service within the applicable time period, such as an annual visit limit.167The specific diagnosis code(s) on this claim aren't covered under the patient's plan.177The patient doesn't currently meet the plan's eligibility criteria for this benefit.187This amount was or should be paid from the patient's consumer-directed spending account, such as an HSA or FSA, rather than by the payer.2This portion of the claim represents the patient's coinsurance share, the percentage of the allowed amount they are responsible for under their plan.200The service date falls within a period when the patient's coverage had lapsed.201The patient is responsible for this amount under a legal set-aside arrangement, commonly seen in workers' compensation Medicare Set-Aside cases, rather than the payer.

Frequently asked questions

What does CARC 228 mean?

A prior payer's claim wasn't fully adjudicated because requested information was never supplied, which is now affecting this claim.

How do I resolve CARC 228?

Complete the outstanding information request with the primary payer, then resubmit to this payer with the primary's finalized EOB.

Why does CARC 228 happen?

A coordination-of-benefits information request from the primary payer was never completed.

CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.