DenialCodePro
226Denial CodeGeneral Adjustment

Code 226

Problem Description

Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

Actionable Fix — Solution Steps

Verify claim details and patient demographics. Submit a corrected claim or appeal with necessary supporting medical documentation.

Related Codes in General Adjustment

1

Deductible Amount

2

Coinsurance Amount

3

Co-payment Amount

6

The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.

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