PR 227 denial code

Claim adjustment reason code 227. Often reported as PR 227.

Patient did not send requested info

Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated Nov 11, 2026.

What 227 means

The payer asked the patient, insured or responsible party for information and it was missing or incomplete.

The hold up is on the patient's side. The payer sent the member something, often a coordination of benefits questionnaire, an accident form or a student status form, and did not get a complete answer.

At least one remark code comes with it and names what was missing. Although the group code is often PR, the quickest path to payment is usually helping the patient respond so the payer can reprocess.

Group codes seen with 227

On a remittance, 227 comes after a group code. These are the ones it is most often reported with:

• PR 227 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.

The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.

Common causes

• The patient did not return a coordination of benefits questionnaire about other insurance.
• An accident or injury questionnaire went unanswered.
• A dependent's student or disability status form was not returned.
• The patient's response was missing signatures or key details.

What to do next

1. Read the remark codes to see which form or answer the payer needs.
2. Call the patient, explain what the payer needs and how to send it.
3. Ask the payer to reprocess the claim once the patient confirms the information was sent.
4. Hold patient statements while the patient is responding, if your policy allows.
5. Bill the patient per your policy only if they decline to respond and the remittance supports it.

Related codes

• 226 (reason code) Provider did not send requested info
• 22 (reason code) Another payer may be primary
• 16 (reason code) Missing information or billing error
• N179 (remark code) Waiting on information from the member