Who has to pay after a code 228 denial?

Who owes depends on the details. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.

How long do I have to appeal?

It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.

All denial codes · code 228

Denial code 228: what it means — and how to fight it

Denial code 228 (shown on your EOB as CO-228 or PR-228) means: “Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer.” In plain English: Somebody did not send a different insurer the information it asked for, so this plan will not pay either. Fixable once you find out who dropped it.

high appealability Who owes depends on the details

What they're really saying

“Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer.”

Somebody did not send a different insurer the information it asked for, so this plan will not pay either. Fixable once you find out who dropped it.

Your odds

Strong — this type of denial has real weaknesses.

High success rate — this is a paperwork failure, not a coverage decision.

Fewer than 1 in 100 denied claims are ever appealed. When people do appeal, roughly 4 in 10 win the first round — and independent external review overturns 40–50% of what reaches it.

How to appeal a code 228 denial

Decode. You just did — this page is step one.
Set your clock. 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, only 65 for Medicare Advantage.
Urgent? If this is care you still need, call and request an expedited appeal — they must decide within 72 hours.
Ask the first insurer what information it wanted and who it asked for it. Call the previous payer and ask exactly what was requested, from whom, and on what date. If it was requested from you, send it and ask both payers to reprocess. If a provider was asked, tell them in writing that their non-response is blocking your claim. Coordination-of-benefits questionnaires are the most common trigger — some plans hold every claim you have until you return one form.
Send it certified. Letter plus evidence, keep copies of everything.
Escalate. Denied again? Independent external review — a doctor who doesn't work for your insurer decides.

Do it in minutes, free

The AppealClock tool translates your denial, drafts your appeal letter, computes your exact deadline — and watches the clock so you don't have to. No account. Your medical details never leave your device.

Start your appeal & set your clock →

Common questions

What does denial code 228 mean?: Somebody did not send a different insurer the information it asked for, so this plan will not pay either. Fixable once you find out who dropped it.
Can I appeal a CO-228 or PR-228 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are high: High success rate — this is a paperwork failure, not a coverage decision. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 228 denial?: Who owes depends on the details. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.
How long do I have to appeal?: It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.