Denial code 226

Insurance will deny the claim with denial code 226 for the following 3 reasons.

1)Information requested from the Doctor (Billing or Rendering) was not provided or

2)The information not provided on timely manner or

3)The data submitted was insufficient/incomplete.

Insurance companies require detailed information such as treatment records, superbills, and itemized bills, also known as medical records, to process and reimburse claims accurately. These documents provide a complete overview of the healthcare services rendered to a patient by healthcare providers. Treatment records contain the specifics of the medical procedures, tests, medications, and consultations provided. Superbills outline the services offered, dates of service, and costs incurred for each visit. Itemized bills break down the charges for each service, procedure, or medication received by the patient. By reviewing these records, insurance companies can verify the necessity and appropriateness of the services provided and ensure they align with the patient’s coverage.

To prevent Denial Code 226, the billing team should follow these steps:

• When filing a claim with an insurance company, it is crucial to ensure that all necessary information, particularly medical records, is submitted promptly and accurately. The inclusion of comprehensive medical records from the billing or rendering provider is essential to support the claim and facilitate efficient processing by the insurance company.
• When assessing documentation to avoid denial code 226, it is imperative to meticulously review for completeness and accuracy. Ensure that all required information is present and accurate to reduce the risk of denials. Missing or incomplete details can result in denial code 226, which can lead to delayed payments and disrupt the billing process.

To handle Denial Code 226 effectively, healthcare providers should take the following steps:

• Whenever you receive this denial code, the very first step is to check the previous collection notes to find out the requested information has already been submitted to insurance company.
• If the requested information has already been submitted, it is important to follow up with the insurance company to ensure that the claim is being processed accurately and in a timely manner.
• If the requested information has not been submitted to the insurance provider, the next crucial step is to obtain the complete supporting medical records for the date of service. This process is essential to ensure that all relevant documentation is provided to the insurance company for proper claim processing.
• There are instances where additional information such as a superbill or itemized bill is required alongside complete medical records. This helps ensure that the insurance company has all the necessary details to process the claim accurately. To meet these requirements and ensure a smooth claims process, it is important to understand the specific information that the insurance company is looking for. One way to determine the exact information required by the insurance company is to check the RARC (Remittance Advice Remark Code) accompanied by the denial code 226. These codes provide valuable insights into why a claim was denied and what specific information is needed to rectify the issue.
• The time frame to submit the requested information to the insurance company from the denial date typically varies depending on the specific guidelines outlined by the insurance provider. So find out the time frame to determine the deadline for submission. If the timely filing limit has not been crossed, it is advisable to resubmit the claim promptly with complete medical records as requested by the insurance company.
• If timely filing limit has already been met, then it is important to communicate with the clients and work accordingly. Because some clients still require the billing team to send requested medical records to the insurance company.

AR caller on call steps for denial code 226:

1. If claim is denied, then ask the following question (May I know the denial date and reason for denial?)
2. If claim denied with denial code 226 (May I know what exact information insurance company looking in order to reimburse the claim?)
3. Find out the time frame (May I know the time limit to submit the requested information?)
4. Get the Mailing address or fax# (May I know the claim mailing address or fax# to submit the requested info?)
5. Finally request EOB and get the claim reference number.