OA (Other Adjustment) Denial Codes

OA adjustments are used when the adjustment does not fit into CO (contractual) or PR (patient responsibility) categories. Common in coordination of benefits situations where a secondary payer adjusts based on the primary payer's payment.

Common scenarios: Coordination of benefits adjustments from secondary payers. Adjustments that cross CO and PR categories. Payer corrections that don't affect provider or patient liability.

Codes: 281 active Financial responsibility: Varies Patient billable: No
Disclaimer
This content is for informational purposes only. Always verify against your payer contracts and current coding guidelines.

All OA Denial Codes

Code Name Category Action
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
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Other Group Codes

CO
Contractual Obligation
PI
Payor Initiated Reduction
PR
Patient Responsibility