| OA-1 | Deductible Amount | patient responsibility | Verify & Resubmit | → |
| OA-2 | Coinsurance Amount | patient responsibility | Verify & Resubmit | → |
| OA-3 | Co-payment Amount | patient responsibility | Verify & Resubmit | → |
| OA-4 | Procedure Code Inconsistent with Modifier | coding error | Verify & Resubmit | → |
| OA-5 | Procedure Code Inconsistent with Place of Service | coding error | Verify & Resubmit | → |
| OA-6 | Procedure/Revenue Code Inconsistent with Patient Age | coding error | Verify & Resubmit | → |
| OA-7 | Procedure/Revenue Code Inconsistent with Patient Gender | coding error | Verify & Resubmit | → |
| OA-8 | Procedure Code Inconsistent with Provider Type/Specialty | coding error | Verify & Resubmit | → |
| OA-9 | Diagnosis Inconsistent with Patient Age | coding error | Verify & Resubmit | → |
| OA-10 | Diagnosis Inconsistent with Patient Gender | coding error | Verify & Resubmit | → |
| OA-11 | Diagnosis Inconsistent with Procedure | coding error | Verify & Resubmit | → |
| OA-12 | Diagnosis Inconsistent with Provider Type | coding error | Verify & Resubmit | → |
| OA-13 | Date of Death Precedes Date of Service | coding error | Verify & Resubmit | → |
| OA-14 | Date of Birth Follows Date of Service | coding error | Verify & Resubmit | → |
| OA-16 | Missing Information or Billing Error | information missing | Review & Decide | → |
| OA-18 | Exact Duplicate Claim/Service | duplicate | Review & Decide | → |
| OA-19 | Workers' Compensation Claim | coverage | Resubmit | → |
| OA-20 | Liability Carrier Responsible | coverage | Resubmit | → |
| OA-21 | No-Fault Carrier Responsible | coverage | Resubmit | → |
| OA-22 | Coordination of Benefits - Another Payer May Cover | coverage | Resubmit | → |
| OA-23 | Prior Payer Adjudication Impact | coverage | Review & Decide | → |
| OA-24 | Charges Covered Under Capitation/Managed Care | fee schedule | Review & Decide | → |
| OA-26 | Expenses Incurred Prior to Coverage | coverage | Verify & Resubmit | → |
| OA-27 | Expenses Incurred After Coverage Terminated | coverage | Verify & Resubmit | → |
| OA-29 | Timely Filing Limit Expired | timely filing | Appeal | → |
| OA-31 | Patient Cannot Be Identified as Insured | coverage | Verify & Resubmit | → |
| OA-32 | Patient Not Eligible Dependent | coverage | Verify & Resubmit | → |
| OA-33 | Insured Has No Dependent Coverage | coverage | Verify & Resubmit | → |
| OA-34 | No Coverage for Newborns | coverage | Verify & Resubmit | → |
| OA-35 | Lifetime Benefit Maximum Reached | coverage | Review & Decide | → |
| OA-39 | Services Denied at Authorization/Pre-certification | authorization | Appeal | → |
| OA-40 | Charges Do Not Meet Emergent/Urgent Care Qualifications | coverage | Appeal | → |
| OA-44 | Prompt-Pay Discount | fee schedule | Review & Decide | → |
| OA-45 | Charge Exceeds Fee Schedule/Maximum Allowable | fee schedule | Review & Decide | → |
| OA-49 | Non-Covered Routine/Preventive Exam | coverage | Appeal | → |
| OA-50 | Non-Covered Service - Not Medically Necessary | coverage | Appeal | → |
| OA-51 | Non-Covered Pre-existing Condition | coverage | Appeal | → |
| OA-53 | Services by Immediate Relative Not Covered | coverage | Review & Decide | → |
| OA-54 | Multiple Physicians/Assistants Not Covered | coverage | Appeal | → |
| OA-55 | Procedure/Treatment Deemed Experimental/Investigational | coverage | Appeal | → |
| OA-56 | Procedure/Treatment Not Proven Effective | coverage | Appeal | → |
| OA-58 | Inappropriate or Invalid Place of Service | coverage | Appeal | → |
| OA-59 | Multiple/Concurrent Procedure Rules Applied | bundling | Review & Decide | → |
| OA-60 | Outpatient Services Not Covered Near Inpatient Stay | bundling | Review & Decide | → |
| OA-61 | Failure to Obtain Second Surgical Opinion | authorization | Appeal | → |
| OA-66 | Blood Deductible | patient responsibility | Verify & Resubmit | → |
| OA-69 | Day Outlier Amount | fee schedule | Review & Decide | → |
| OA-70 | Cost Outlier Adjustment | fee schedule | Review & Decide | → |
| OA-74 | Indirect Medical Education Adjustment | other | Resubmit | → |
| OA-75 | Direct Medical Education Adjustment | other | Resubmit | → |
| OA-76 | Disproportionate Share Adjustment | other | Resubmit | → |
| OA-78 | Non-Covered Days / Room Charge Adjustment | coverage | Review & Decide | → |
| OA-85 | Patient Interest Adjustment | other | Review & Decide | → |
| OA-89 | Professional Fees Removed from Charges | other | Review & Decide | → |
| OA-90 | Ingredient Cost Adjustment | other | Review & Decide | → |
| OA-91 | Dispensing Fee Adjustment | other | Review & Decide | → |
| OA-94 | Processed in Excess of Charges | other | Review & Decide | → |
| OA-95 | Plan Procedures Not Followed | other | Review & Decide | → |
| OA-96 | Non-Covered Charges | coverage | Review & Decide | → |
| OA-97 | Bundled Service — Not Paid Separately | bundling | Review & Decide | → |
| OA-100 | Payment Made to Patient/Insured | other | Collect from Patient | → |
| OA-101 | Predetermination: Anticipated Payment | other | Review & Decide | → |
| OA-102 | Major Medical Adjustment | other | Review & Decide | → |
| OA-103 | Provider Promotional Discount | other | Review & Decide | → |
| OA-104 | Managed Care Withhold | other | Review & Decide | → |
| OA-105 | Tax Withholding Amount | other | Verify & Resubmit | → |
| OA-106 | Patient Payment Option Not in Effect | other | Review & Decide | → |
| OA-107 | Related or Qualifying Service Not Identified | other | Review & Decide | → |
| OA-108 | Rent/Purchase Guidelines Not Met | other | Review & Decide | → |
| OA-109 | Claim Not Covered by This Payer | coverage | Review & Decide | → |
| OA-110 | Billing Date Predates Service Date | other | Review & Decide | → |
| OA-111 | Not Covered Unless Provider Accepts Assignment | coverage | Review & Decide | → |
| OA-112 | Service Not Furnished Directly or Not Documented | other | Review & Decide | → |
| OA-114 | Procedure/Product Not FDA Approved | other | Review & Decide | → |
| OA-115 | Procedure Postponed, Canceled, or Delayed | other | Review & Decide | → |
| OA-116 | Advance Indemnification Notice Requirements Not Met | other | Review & Decide | → |
| OA-117 | Transportation to Nearest Facility | other | Review & Decide | → |
| OA-118 | ESRD Network Support Adjustment | other | Review & Decide | → |
| OA-119 | Benefit Maximum Reached | other | Review & Decide | → |
| OA-121 | Indemnification Adjustment | other | Review & Decide | → |
| OA-122 | Psychiatric Services Reduction | other | Review & Decide | → |
| OA-128 | Newborn Services in Mother's Allowance | other | Review & Decide | → |
| OA-129 | Prior Processing Information Incorrect | other | Review & Decide | → |
| OA-130 | Claim Submission Fee | other | Review & Decide | → |
| OA-131 | Claim-Specific Negotiated Discount | other | Review & Decide | → |
| OA-132 | Prearranged Demonstration Project Adjustment | other | Review & Decide | → |
| OA-133 | Service Line Pending Further Review | other | Verify & Resubmit | → |
| OA-134 | Technical Fees Removed | other | Review & Decide | → |
| OA-135 | Interim Bills Cannot Be Processed | other | Review & Decide | → |
| OA-136 | Failure to Follow Prior Payer's Coverage Rules | other | Verify & Resubmit | → |
| OA-137 | Regulatory Surcharges, Assessments, or Health-Related Taxes | other | Review & Decide | → |
| OA-139 | Contracted Funding Agreement — Subscriber Employed by Provider | fee schedule | Review & Decide | → |
| OA-140 | Patient ID Number and Name Do Not Match | other | Review & Decide | → |
| OA-142 | Monthly Medicaid Patient Liability Amount | other | Review & Decide | → |
| OA-143 | Portion of Payment Deferred | other | Review & Decide | → |
| OA-144 | Incentive Adjustment for Preferred Product/Service | other | Review & Decide | → |
| OA-146 | Diagnosis Invalid for Date of Service | information missing | Review & Decide | → |
| OA-147 | Provider Accepted Reduced Payment from Regulatory Authority | other | Review & Decide | → |
| OA-148 | Information from Another Provider Not Provided or Incomplete | information missing | Review & Decide | → |
| OA-149 | Lifetime Benefit Maximum Reached | other | Review & Decide | → |
| OA-150 | Information Does Not Support Level of Service | other | Review & Decide | → |
| OA-151 | Information Does Not Support Frequency of Services | other | Review & Decide | → |
| OA-152 | Information Does Not Support Length of Service | other | Review & Decide | → |
| OA-153 | Information Does Not Support Dosage | other | Review & Decide | → |
| OA-154 | Information Does Not Support Day's Supply | other | Review & Decide | → |
| OA-155 | Patient Refused the Service/Procedure | other | Review & Decide | → |
| OA-157 | Service Provided as Result of Act of War | other | Review & Decide | → |
| OA-158 | Service Provided Outside the United States | other | Review & Decide | → |
| OA-159 | Service Provided as Result of Terrorism | other | Review & Decide | → |
| OA-160 | Benefit Exclusion: Injury from Excluded Activity | other | Review & Decide | → |
| OA-161 | Provider Performance Bonus | other | Review & Decide | → |
| OA-163 | Attachment/Documentation Referenced on Claim Not Received | other | Review & Decide | → |
| OA-164 | Attachment/Documentation Not Received in Timely Fashion | other | Review & Decide | → |
| OA-166 | Payer's Responsibility Ended Before Service Date | other | Review & Decide | → |
| OA-167 | Diagnosis Not Covered | coverage | Review & Decide | → |
| OA-169 | Alternate Benefit Provided | other | Review & Decide | → |
| OA-170 | Payment Denied for This Provider Type | other | Review & Decide | → |
| OA-171 | Payment Denied for Provider Type in This Facility Type | other | Review & Decide | → |
| OA-172 | Payment Adjusted for Provider Specialty | other | Review & Decide | → |
| OA-173 | Service Not Prescribed by a Physician | other | Review & Decide | → |
| OA-174 | Service Not Prescribed Prior to Delivery | other | Review & Decide | → |
| OA-175 | Prescription Is Incomplete | information missing | Review & Decide | → |
| OA-176 | Prescription Is Not Current | other | Review & Decide | → |
| OA-177 | Patient Has Not Met Required Eligibility Requirements | other | Review & Decide | → |
| OA-178 | Patient Has Not Met Spend Down Requirements | other | Review & Decide | → |
| OA-179 | Patient Has Not Met Required Waiting Period | other | Review & Decide | → |
| OA-180 | Patient Has Not Met Residency Requirements | other | Review & Decide | → |
| OA-181 | Procedure Code Invalid on Date of Service | information missing | Review & Decide | → |
| OA-182 | Procedure Modifier Invalid on Date of Service | coding error | Review & Decide | → |
| OA-183 | Referring Provider Not Eligible to Refer | other | Review & Decide | → |
| OA-184 | Prescribing/Ordering Provider Not Eligible to Prescribe/Order | other | Review & Decide | → |
| OA-185 | Rendering Provider Not Eligible to Perform Service | other | Review & Decide | → |
| OA-186 | Level of Care Change Adjustment | other | Review & Decide | → |
| OA-187 | Consumer Spending Account Payment Not Approved | other | Review & Decide | → |
| OA-188 | Product/Procedure Not Covered Unless FDA-Recommended | coverage | Review & Decide | → |
| OA-189 | No Specific Procedure Code for Service Billed | other | Review & Decide | → |
| OA-190 | Billing for SNF Qualified Stay Already Covered | other | Review & Decide | → |
| OA-192 | Non-Standard Adjustment Code from Paper Remittance | other | Review & Decide | → |
| OA-193 | Original Payment Decision Maintained on Review | other | Review & Decide | → |
| OA-194 | Anesthesia by Operating/Assistant/Attending Physician | other | Review & Decide | → |
| OA-195 | Refund to Erroneous Priority Payer | other | Verify & Resubmit | → |
| OA-197 | Precertification/Authorization/Notification Absent | authorization | Review & Decide | → |
| OA-198 | Precertification/Authorization Limits Exceeded | authorization | Review & Decide | → |
| OA-199 | Revenue Code and Procedure Code Mismatch | coding error | Verify & Resubmit | → |
| OA-200 | Expenses Incurred During Lapse in Coverage | coverage | Review & Decide | → |
| OA-201 | Patient Responsibility via Set-Aside Arrangement | other | Review & Decide | → |
| OA-202 | Non-Covered Personal Comfort or Convenience Services | coverage | Review & Decide | → |
| OA-203 | Discontinued or Reduced Service | coverage | Review & Decide | → |
| OA-204 | Service/Equipment/Drug Not Covered Under Benefit Plan | coverage | Review & Decide | → |
| OA-205 | Pharmacy Discount Card Processing Fee | fee schedule | Review & Decide | → |
| OA-206 | National Provider Identifier - Missing | information missing | Verify & Resubmit | → |
| OA-207 | National Provider Identifier - Invalid Format | information missing | Verify & Resubmit | → |
| OA-208 | National Provider Identifier - Not Matched | information missing | Verify & Resubmit | → |
| OA-209 | Provider Cannot Collect from Patient per Regulatory Agreement | other | Review & Decide | → |
| OA-210 | Pre-Certification/Authorization Not Received Timely | authorization | Review & Decide | → |
| OA-211 | National Drug Codes (NDC) Not Eligible for Rebate, Not Covered | coverage | Review & Decide | → |
| OA-212 | Administrative Surcharges Not Covered | fee schedule | Review & Decide | → |
| OA-213 | Non-Compliance with Physician Self-Referral Prohibition | other | Review & Decide | → |
| OA-215 | Based on Subrogation of a Third Party Settlement | other | Review & Decide | → |
| OA-216 | Based on Findings of a Review Organization | other | Review & Decide | → |
| OA-219 | Based on Extent of Injury | other | Review & Decide | → |
| OA-222 | Exceeds Contracted Maximum Hours/Days/Units | fee schedule | Review & Decide | → |
| OA-223 | Mandated Federal/State/Local Law Adjustment | other | Review & Decide | → |
| OA-224 | Patient Identification Compromised by Identity Theft | other | Verify & Resubmit | → |
| OA-225 | Penalty or Interest Payment by Payer | other | Review & Decide | → |
| OA-226 | Provider Information Not Provided or Insufficient | information missing | Verify & Resubmit | → |
| OA-227 | Patient/Insured Information Not Provided or Insufficient | information missing | Verify & Resubmit | → |
| OA-228 | Denied for Failure to Supply Information to Previous Payer | information missing | Verify & Resubmit | → |
| OA-229 | Partial Charge Not Considered Due to Type of Bill 12X | other | Review & Decide | → |
| OA-231 | Mutually Exclusive Procedures | bundling | Verify & Resubmit | → |
| OA-232 | Institutional Transfer Amount | fee schedule | Review & Decide | → |
| OA-233 | Hospital-Acquired Condition or Preventable Medical Error | other | Review & Decide | → |
| OA-234 | Procedure Not Paid Separately | bundling | Review & Decide | → |
| OA-235 | Sales Tax | fee schedule | Review & Decide | → |
| OA-236 | Procedure/Modifier Not Compatible per NCCI | bundling | Verify & Resubmit | → |
| OA-237 | Legislated/Regulatory Penalty | other | Review & Decide | → |
| OA-238 | Claim Spans Eligible/Ineligible Periods - Ineligible Reduction | other | Review & Decide | → |
| OA-239 | Claim Spans Eligible/Ineligible Periods - Rebill Separately | coverage | Verify & Resubmit | → |
| OA-240 | Diagnosis Inconsistent with Patient's Birth Weight | coding error | Verify & Resubmit | → |
| OA-241 | Low Income Subsidy (LIS) Co-payment Amount | patient responsibility | Review & Decide | → |
| OA-242 | Services Not Provided by Network/Primary Care Providers | coverage | Review & Decide | → |
| OA-243 | Services Not Authorized by Network/Primary Care Providers | authorization | Review & Decide | → |
| OA-245 | Provider Performance Program Withhold | fee schedule | Review & Decide | → |
| OA-246 | Non-Payable Code for Required Reporting Only | other | Review & Decide | → |
| OA-247 | Deductible for Professional Service in Institutional Setting | patient responsibility | Review & Decide | → |
| OA-248 | Coinsurance for Professional Service in Institutional Setting | patient responsibility | Review & Decide | → |
| OA-249 | Claim Identified as Readmission | other | Review & Decide | → |
| OA-250 | Incorrect Attachment/Documentation Received | information missing | Verify & Resubmit | → |
| OA-251 | Incomplete or Deficient Attachment/Documentation Received | information missing | Verify & Resubmit | → |
| OA-252 | Attachment Required to Adjudicate Claim | other | Resubmit | → |
| OA-253 | Sequestration Reduction in Federal Payment | other | Review & Decide | → |
| OA-254 | Dental Plan Benefits Not Available - Submit to Medical | other | Review & Decide | → |
| OA-256 | Service Not Payable Per Managed Care Contract | other | Review & Decide | → |
| OA-257 | Claim Undetermined During Premium Grace Period (HIX) | coverage | Review & Decide | → |
| OA-258 | Claim Not Covered - Patient in Custody or Incarcerated | coverage | Review & Decide | → |
| OA-259 | Additional Payment for Dental/Vision Service Utilization | other | Review & Decide | → |
| OA-260 | Processed Under Medicaid ACA Enhanced Fee Schedule | fee schedule | Review & Decide | → |
| OA-261 | Procedure Inconsistent with Patient History | coding error | Review & Decide | → |
| OA-262 | Adjustment for Delivery Cost (Pharmaceuticals Only) | other | Review & Decide | → |
| OA-263 | Adjustment for Shipping Cost (Pharmaceuticals Only) | other | Review & Decide | → |
| OA-264 | Adjustment for Postage Cost (Pharmaceuticals Only) | other | Review & Decide | → |
| OA-265 | Adjustment for Administrative Cost (Pharmaceuticals Only) | other | Review & Decide | → |
| OA-266 | Adjustment for Compound Preparation Cost (Pharmaceuticals Only) | other | Review & Decide | → |
| OA-267 | Claim/Service Spans Multiple Months | other | Review & Decide | → |
| OA-268 | Claim Spans Two Calendar Years | other | Review & Decide | → |
| OA-269 | Anesthesia Not Covered for This Procedure | coverage | Review & Decide | → |
| OA-270 | Medical Plan Benefits Not Available - Submit to Dental | other | Review & Decide | → |
| OA-271 | Prior Contractual Reductions on Current Payment Schedule | fee schedule | Review & Decide | → |
| OA-272 | Coverage/Program Guidelines Were Not Met | other | Review & Decide | → |
| OA-273 | Coverage/Program Guidelines Were Exceeded | other | Review & Decide | → |
| OA-274 | Fee/Service Not Payable — Care Coordination Arrangement | coverage | Review & Decide | → |
| OA-275 | Prior Payer Patient Responsibility Not Covered | coverage | Review & Decide | → |
| OA-276 | Prior Payer Denied Services Not Covered by This Payer | coverage | Review & Decide | → |
| OA-277 | Claim Undetermined During SHOP Exchange Grace Period | coverage | Review & Decide | → |
| OA-278 | Performance Program Proficiency Requirements Not Met | other | Review & Decide | → |
| OA-279 | Services Not Provided by Preferred Network Providers | other | Review & Decide | → |
| OA-280 | Medical Plan Benefits Not Available - Submit to Pharmacy | other | Review & Decide | → |
| OA-281 | Deductible Waived Per Contractual Agreement | patient responsibility | Review & Decide | → |
| OA-282 | Procedure/Revenue Code Does Not Match Type of Bill | other | Review & Decide | → |
| OA-283 | Attending Provider Not Eligible to Direct Care | other | Review & Decide | → |
| OA-284 | Authorization Valid But Does Not Apply to Billed Services | authorization | Review & Decide | → |
| OA-285 | Appeal Procedures Not Followed | other | Review & Decide | → |
| OA-286 | Appeal Time Limits Not Met | other | Review & Decide | → |
| OA-287 | Referral Exceeded | authorization | Review & Decide | → |
| OA-288 | Referral Absent | authorization | Review & Decide | → |
| OA-289 | Dental and Medical Plans Considered - Benefits Not Available | other | Review & Decide | → |
| OA-290 | Dental Plan Benefits Not Available - Forwarded to Medical | other | Review & Decide | → |
| OA-291 | Medical Plan Benefits Not Available - Forwarded to Dental | other | Review & Decide | → |
| OA-292 | Medical Plan Benefits Not Available - Forwarded to Pharmacy | other | Review & Decide | → |
| OA-293 | Payment Made to Employer | other | Review & Decide | → |
| OA-294 | Payment Made to Attorney | other | Review & Decide | → |
| OA-295 | Pharmacy Direct/Indirect Remuneration (DIR) Adjustment | other | Review & Decide | → |
| OA-296 | Authorization Valid But Does Not Apply to Provider | authorization | Review & Decide | → |
| OA-297 | Medical Plan Benefits Not Available - Submit to Vision | other | Review & Decide | → |
| OA-298 | Medical Plan Benefits Not Available - Forwarded to Vision | other | Review & Decide | → |
| OA-299 | Billing Provider Not Eligible for Payment | other | Review & Decide | → |
| OA-300 | Medical Plan Benefits Not Available - Submit to Behavioral Health | other | Review & Decide | → |
| OA-301 | Medical Plan Claim — Submit to Behavioral Health Plan | coverage | Verify & Resubmit | → |
| OA-302 | Precertification/Authorization Time Limit Expired | authorization | Verify & Resubmit | → |
| OA-303 | Prior Payer Patient Responsibility Not Covered for QMB | patient responsibility | Review & Decide | → |
| OA-304 | Medical Plan Claim — Submit to Hearing Plan | coverage | Verify & Resubmit | → |
| OA-305 | Medical Plan Claim — Forwarded to Hearing Plan | coverage | Review & Decide | → |
| OA-306 | Type of Bill Inconsistent with Patient Status | information missing | Resubmit | → |
| OA-307 | Medicare Maximum Fair Price Standard Default Refund Amount | fee schedule | Review & Decide | → |
| OA-308 | Contracted Funding Agreement Adjustment | fee schedule | Review & Decide | → |
| OA-A0 | Patient Refund Amount | other | Review & Decide | → |
| OA-A1 | Claim/Service Denied — Remark Code Required | other | Review & Decide | → |
| OA-A5 | Medicare PPS Capital Cost Outlier Amount | fee schedule | Review & Decide | → |
| OA-A6 | Prior Hospitalization or 30-Day Transfer Requirement Not Met | coverage | Review & Decide | → |
| OA-A8 | Ungroupable DRG | coding error | Verify & Resubmit | → |
| OA-B1 | Non-Covered Visits | coverage | Review & Decide | → |
| OA-B10 | Allowed Amount Reduced — Component of Basic Procedure Already Paid | bundling | Review & Decide | → |
| OA-B11 | Claim Transferred to Proper Payer — Not Covered Here | coverage | Verify & Resubmit | → |
| OA-B12 | Services Not Documented in Patient Medical Records | information missing | Appeal | → |
| OA-B13 | Previously Paid — Duplicate Payment | duplicate | Review & Decide | → |
| OA-B14 | Only One Visit/Consultation Per Physician Per Day Covered | other | Review & Decide | → |
| OA-B15 | Qualifying Service/Procedure Not Received or Covered | other | Review & Decide | → |
| OA-B16 | New Patient Qualifications Not Met | other | Review & Decide | → |
| OA-B20 | Service Partially or Fully Furnished by Another Provider | duplicate | Review & Decide | → |
| OA-B22 | Payment Adjusted Based on Diagnosis | coding error | Review & Decide | → |
| OA-B23 | Procedure Not Authorized Per CLIA Proficiency Test | other | Review & Decide | → |
| OA-B4 | Late Filing Penalty | other | Review & Decide | → |
| OA-B7 | Provider Not Certified/Eligible for This Service on This Date | coverage | Verify & Resubmit | → |
| OA-B8 | Alternative Services Available — Should Have Been Utilized | other | Review & Decide | → |
| OA-B9 | Patient Enrolled in Hospice | coverage | Verify & Resubmit | → |
| OA-P1 | State-Mandated Requirement — Property and Casualty Only | other | Review & Decide | → |
| OA-P10 | Payment Reduced to Zero Due to Litigation — P&C Only | other | Review & Decide | → |
| OA-P11 | P&C Claim Disposition Pending Due to Litigation | other | Review & Decide | → |
| OA-P12 | Workers' Compensation Jurisdictional Fee Schedule Adjustment | fee schedule | Review & Decide | → |
| OA-P13 | Payment Reduced/Denied Per WC Jurisdictional Regulations | coverage | Review & Decide | → |
| OA-P14 | Service Included in Another Service Payment — P&C Only | bundling | Review & Decide | → |
| OA-P15 | WC Medical Treatment Guideline Adjustment | coverage | Review & Decide | → |
| OA-P16 | Provider Not Authorized for WC Treatment in This Jurisdiction | other | Review & Decide | → |
| OA-P2 | Not Work-Related — Workers' Compensation Not Liable | coverage | Verify & Resubmit | → |
| OA-P3 | Workers' Compensation Case Settled — Patient Responsible via MSA | other | Review & Decide | → |
| OA-P4 | Workers' Compensation Claim Non-Compensable | coverage | Verify & Resubmit | → |
| OA-P5 | Reasonable and Customary Fee Adjustment — P&C Only | fee schedule | Review & Decide | → |
| OA-P6 | Adjustment Based on Entitlement to Benefits — P&C Only | coverage | Review & Decide | → |
| OA-P7 | Billed Code Not in Fee Schedule/Database — P&C Only | fee schedule | Verify & Resubmit | → |
| OA-P8 | Claim Under Investigation — P&C Only | other | Review & Decide | → |
| OA-P9 | No CPT/HCPCS Code Available — P&C Only | coding error | Resubmit | → |