CO-226 — Requested records not received from provider
Claim-adjustment reason code 226 · typically reported as CO-226
What it means
The payer asked you for documentation (development/ADR request) and didn’t get it — or got it incomplete — so it denied.
Why DME claims hit it
- ADR letters missed because they went to a stale correspondence address
- Partial chart sent: missing F2F, SWO, or proof of delivery
- Response sent after the deadline
How to fix it
- Centralize ADR intake with deadline tracking
- Send the COMPLETE documentation package (order, F2F, clinical notes, POD) — use a checklist per item type
- After denial: submit the full package with a redetermination request
Appeal posture
Yes — appeal with the complete records; these reverse routinely when the documentation actually exists.
Related denial codes
CO-252 — Attachment / documentation requiredCO-50 — Not deemed medically necessaryCO-29 — Filed past the timely-filing limit
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