| OA-1 | Deductible Amount | patient responsibility | Review & Decide | → |
| OA-4 | Procedure Code / Modifier Mismatch | coding error | Resubmit | → |
| OA-5 | Procedure Code Inconsistent with Place of Service | coding error | Review & Decide | → |
| OA-11 | Diagnosis Inconsistent with Procedure | coding error | Review & Decide | → |
| OA-13 | Date of Death Precedes Date of Service | other | Review & Decide | → |
| OA-16 | Missing Information or Billing Error | information missing | Review & Decide | → |
| OA-18 | Exact Duplicate Claim or Service | duplicate | Verify & Resubmit | → |
| OA-19 | Workers' Compensation Claim | other | Review & Decide | → |
| OA-20 | Liability Carrier Responsible | other | Review & Decide | → |
| OA-21 | No-Fault Carrier Responsible | other | Review & Decide | → |
| OA-22 | Care Covered by Another Payer (COB) | other | Review & Decide | → |
| OA-23 | Impact of Prior Payer Adjudication | coverage | Review & Decide | → |
| OA-24 | Charges Covered Under Capitation or Managed Care | other | Review & Decide | → |
| OA-29 | Timely Filing Limit Expired | timely filing | Review & Decide | → |
| OA-31 | Patient Not Identified as Insured | information missing | Verify & Resubmit | → |
| OA-32 | Patient Not Eligible as Dependent | coverage | Verify & Resubmit | → |
| OA-35 | Lifetime Benefit Maximum Reached | coverage | Review & Decide | → |
| OA-44 | Prompt-Pay Discount | fee schedule | Review & Decide | → |
| OA-45 | Charge Exceeds Fee Schedule / Maximum Allowable | fee schedule | Review & Decide | → |
| OA-49 | Routine/Preventive Exam Not Covered | coverage | Review & Decide | → |
| OA-53 | Payment Adjusted Due to Prior Payer Adjudication | other | Review & Decide | → |
| OA-54 | Multiple Physicians/Assistants Not Covered | other | Review & Decide | → |
| OA-59 | Multiple / Concurrent Procedure Payment Reduction | fee schedule | Review & Decide | → |
| OA-60 | Outpatient Services Not Covered Near Inpatient Stay | bundling | Review & Decide | → |
| OA-69 | Day Outlier Amount | other | Resubmit | → |
| OA-70 | Cost Outlier Adjustment | other | Resubmit | → |
| 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-89 | Professional Fees Removed from Charges | other | Resubmit | → |
| OA-90 | Ingredient Cost Adjustment | other | Resubmit | → |
| 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-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-107 | Related or Qualifying Service Not Identified | other | Review & Decide | → |
| OA-109 | Claim Not Covered by This Payer | coverage | Review & Decide | → |
| OA-115 | Procedure Postponed, Canceled, or Delayed | 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-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 | Review & Decide | → |
| OA-134 | Technical Fees Removed | fee schedule | Review & Decide | → |
| OA-135 | Interim Bills Cannot Be Processed | other | Review & Decide | → |
| OA-136 | Failure to Follow Prior Payer's Coverage Rules | coverage | Verify & Resubmit | → |
| OA-137 | Regulatory Surcharges, Assessments, or Health-Related Taxes | fee schedule | Verify & Resubmit | → |
| 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 Code Invalid for Date of Service | information missing | Review & Decide | → |
| OA-148 | Incomplete or Missing Information from Another Provider | information missing | Review & Decide | → |
| OA-149 | Lifetime Benefit Maximum Reached | other | Review & Decide | → |
| OA-150 | Documentation Does Not Support Level of Service | other | Review & Decide | → |
| OA-151 | Documentation Does Not Support Service Frequency | other | Review & Decide | → |
| OA-152 | Documentation Does Not Support Length of Service | other | Review & Decide | → |
| OA-155 | Patient Refused the Service/Procedure | other | Review & Decide | → |
| OA-157 | Service Denied — Provided Due to 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 | coverage | Review & Decide | → |
| OA-160 | Benefit Exclusion — Activity-Related Injury/Illness | other | Review & Decide | → |
| OA-161 | Provider Performance Bonus | other | Review & Decide | → |
| OA-163 | Attachment/Documentation Not Received | other | Review & Decide | → |
| OA-164 | Attachment/Documentation Not Received Timely | other | Review & Decide | → |
| OA-166 | Payer's Plan Responsibility Ended | other | Review & Decide | → |
| OA-167 | Diagnosis Not Covered | coverage | Review & Decide | → |
| OA-169 | Alternate Benefit Provided | other | Review & Decide | → |
| OA-170 | Payment Denied — Provider Type Not Eligible | other | Review & Decide | → |
| OA-172 | Provider Specialty Adjustment | other | Review & Decide | → |
| OA-173 | Service/Equipment Not Prescribed by Physician | other | Review & Decide | → |
| OA-174 | Service Not Prescribed Prior to Delivery | other | Review & Decide | → |
| OA-175 | Incomplete Prescription | information missing | Review & Decide | → |
| OA-176 | Prescription Not Current | other | Review & Decide | → |
| OA-177 | Patient Eligibility Requirements Not Met | other | Review & Decide | → |
| OA-178 | Spend Down Requirements Not Met | other | Review & Decide | → |
| OA-181 | Invalid Procedure Code on Date of Service | information missing | Review & Decide | → |
| OA-182 | Invalid Procedure Modifier | coding error | Review & Decide | → |
| OA-183 | Referring Provider Not Authorized to Refer | other | Review & Decide | → |
| OA-184 | Ordering/Prescribing Provider Not Eligible | 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-189 | Unlisted/NOC Code Used When Specific Code Exists | other | Review & Decide | → |
| OA-190 | Payment Included in SNF Qualified Stay Allowance | other | Review & Decide | → |
| OA-192 | Non-Standard COB Adjustment Code | other | Verify & Resubmit | → |
| OA-193 | Original Payment Decision Maintained | other | Review & Decide | → |
| OA-194 | Anesthesia by Operating/Assistant/Attending Physician | other | Review & Decide | → |
| OA-195 | Refund Issued to Wrong Payer | other | Verify & Resubmit | → |
| OA-198 | Precertification/Authorization Limits Exceeded | authorization | Review & Decide | → |
| OA-199 | Revenue Code / Procedure Code Mismatch | coding error | Review & Decide | → |
| OA-200 | Expenses Incurred During Lapse in Coverage | coverage | Review & Decide | → |
| OA-203 | Discontinued or Reduced Service | other | Review & Decide | → |
| OA-204 | Service/Equipment/Drug Not Covered Under Benefit Plan | coverage | Review & Decide | → |
| OA-205 | Pharmacy Discount Card Processing Fee | other | Review & Decide | → |
| OA-206 | NPI Not On File With Payer | other | Review & Decide | → |
| OA-208 | NPI Billing Provider Not Matched | other | Review & Decide | → |
| OA-209 | Regulatory Non-Collectible Amount | patient responsibility | Verify & Resubmit | → |
| OA-213 | Physician Self-Referral Prohibition Violation | authorization | Review & Decide | → |
| OA-215 | Third Party Subrogation Settlement | coverage | Verify & Resubmit | → |
| OA-216 | Review Organization Findings | other | Review & Decide | → |
| OA-219 | Extent of Injury Adjustment | coverage | Verify & Resubmit | → |
| OA-222 | Exceeds Contracted Maximum Units | fee schedule | Review & Decide | → |
| OA-223 | Mandated Federal/State/Local Law Adjustment | other | Review & Decide | → |
| OA-224 | Patient Identity Compromised | other | Verify & Resubmit | → |
| OA-225 | Penalty or Interest Payment by Payer | other | Review & Decide | → |
| OA-226 | Provider Information Not Provided or Incomplete | information missing | Review & Decide | → |
| OA-228 | Information Not Provided to Previous Payer | information missing | Review & Decide | → |
| OA-231 | Mutually Exclusive Procedures on Same Day | bundling | Review & Decide | → |
| OA-232 | Institutional Transfer DRG Difference | fee schedule | Review & Decide | → |
| OA-233 | Hospital-Acquired Condition or Preventable Error | other | Review & Decide | → |
| OA-234 | Procedure Not Paid Separately (Bundled) | bundling | Review & Decide | → |
| OA-236 | Incompatible Procedure/Modifier Combination | bundling | Review & Decide | → |
| OA-237 | Legislated or Regulatory Penalty | other | Review & Decide | → |
| OA-239 | Claim Spans Eligible and Ineligible Periods — Rebill | coverage | Review & Decide | → |
| OA-240 | Diagnosis Inconsistent with Birth Weight | coding error | Review & Decide | → |
| OA-242 | Services Not Provided by Network Provider | coverage | Review & Decide | → |
| OA-243 | Services Not Authorized by Network Provider | authorization | Review & Decide | → |
| OA-245 | Provider Performance Program Withhold | fee schedule | Review & Decide | → |
| OA-257 | Grace Period Pending — Claim Disposition Undetermined | coverage | Review & Decide | → |
| OA-259 | Additional Payment for Dental/Vision Service Utilization | other | Review & Decide | → |
| OA-260 | Medicaid ACA Enhanced Fee Schedule Adjustment | fee schedule | Verify & Resubmit | → |
| OA-261 | Procedure Inconsistent with Patient History | coding error | Review & Decide | → |
| OA-262 | Pharmaceutical Delivery Cost Adjustment | fee schedule | Verify & Resubmit | → |
| OA-263 | Pharmaceutical Shipping Cost Adjustment | fee schedule | Verify & Resubmit | → |
| OA-264 | Pharmaceutical Postage Cost Adjustment | fee schedule | Verify & Resubmit | → |
| OA-265 | Pharmaceutical Administrative Cost Adjustment | fee schedule | Verify & Resubmit | → |
| OA-266 | Pharmaceutical Compound Preparation Cost Adjustment | fee schedule | Verify & Resubmit | → |
| OA-267 | Claim Spans Multiple Months | information missing | Resubmit | → |
| OA-270 | Submit to Dental Plan Instead | coverage | Verify & Resubmit | → |
| OA-271 | Prior Contractual Reduction on Periodic Payment | fee schedule | Review & Decide | → |
| OA-272 | Coverage/Program Guidelines Not Met | other | Review & Decide | → |
| OA-273 | Coverage/Program Guidelines Exceeded | other | Review & Decide | → |
| OA-274 | Fee/Service Not Payable — Care Coordination Arrangement | coverage | Review & Decide | → |
| OA-276 | Services Denied by Prior Payer Not Covered | coverage | Review & Decide | → |
| OA-277 | Claim Undetermined During Premium Grace Period (SHOP) | coverage | Review & Decide | → |
| OA-280 | Claim Received but Benefits Not Covered — Submit to Pharmacy Plan | coverage | Resubmit | → |
| OA-288 | Referral Absent / Missing Referral | information missing | Review & Decide | → |
| OA-289 | Dental/Medical Plan Benefits Not Available | coverage | Review & Decide | → |
| OA-290 | Dental Plan Claim Forwarded to Medical Plan | coverage | Verify & Resubmit | → |
| OA-291 | Medical Plan Claim Forwarded to Dental Plan | coverage | Verify & Resubmit | → |
| OA-292 | Medical Plan Claim Forwarded to Pharmacy Plan | coverage | Verify & Resubmit | → |
| 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 | fee schedule | Review & Decide | → |
| OA-296 | Precertification/Authorization Number Does Not Apply to Provider | authorization | Review & Decide | → |
| OA-297 | Medical Plan Claim — Submit to Vision Plan | coverage | Verify & Resubmit | → |
| OA-298 | Medical Plan Claim Forwarded to Vision Plan | coverage | Verify & Resubmit | → |
| OA-299 | Billing Provider Not Eligible for Payment | other | Review & Decide | → |
| OA-300 | Medical Plan Claim Forwarded to Behavioral Health Plan | coverage | Verify & Resubmit | → |
| OA-301 | Medical Plan Claim — Submit to Behavioral Health Plan | coverage | Verify & Resubmit | → |
| OA-302 | Authorization Time Limit Expired | authorization | Review & Decide | → |
| OA-303 | QMB Patient Responsibility Not Covered | coverage | Review & Decide | → |
| OA-304 | Benefits Not Available — Submit to Hearing Plan | other | Review & Decide | → |
| OA-305 | Claim Forwarded to Hearing Plan | coverage | Verify & Resubmit | → |
| OA-306 | Type of Bill Inconsistent with Patient Status | coding error | Review & Decide | → |
| OA-307 | Medicare Drug Price Negotiation Refund | fee schedule | Review & Decide | → |
| OA-A0 | Patient Refund Amount | other | Review & Decide | → |
| OA-A1 | Missing Remark Code | information missing | Verify & Resubmit | → |
| OA-A5 | Medicare PPS Capital Cost Outlier Amount | other | Review & Decide | → |
| OA-A6 | Prior Hospitalization or 30-Day Transfer Requirement Not Met | other | Review & Decide | → |
| OA-A8 | Ungroupable DRG | other | Review & Decide | → |
| OA-B1 | Non-Covered Visits | coverage | Review & Decide | → |
| OA-B10 | Allowed Amount Reduced — Component Already Paid | bundling | Verify & Resubmit | → |
| OA-B11 | Claim Transferred to Proper Payer | coverage | Verify & Resubmit | → |
| OA-B12 | Services Not Documented in Medical Records | information missing | Appeal | → |
| OA-B13 | Previously Paid Service | duplicate | Review & Decide | → |
| OA-B14 | Only One Visit Per Physician Per Day Covered | duplicate | Verify & Resubmit | → |
| OA-B15 | Qualifying Service/Procedure Not Received | bundling | Verify & Resubmit | → |
| OA-B16 | New Patient Qualifications Not Met | coding error | Verify & Resubmit | → |
| OA-B20 | Service Furnished by Another Provider | duplicate | Verify & Resubmit | → |
| OA-B22 | Payment Adjusted Based on Diagnosis | coding error | Review & Decide | → |
| OA-B23 | Procedure Not Authorized per CLIA Proficiency Test | coverage | Verify & Resubmit | → |
| OA-B4 | Late Filing Penalty | other | Review & Decide | → |
| OA-B7 | Provider Not Certified/Eligible | other | Review & Decide | → |
| OA-B8 | Alternative Services Not Utilized | coverage | Appeal | → |
| OA-B9 | Patient Enrolled in Hospice | coverage | Verify & Resubmit | → |
| OA-P1 | State Mandated Requirement — Property and Casualty | other | Verify & Resubmit | → |
| OA-P10 | Payment Reduced to Zero Pending Litigation | other | Review & Decide | → |
| OA-P11 | P&C Claim Disposition Pending Litigation | other | Review & Decide | → |
| OA-P12 | Workers' Compensation Jurisdictional Fee Schedule Adjustment | fee schedule | Review & Decide | → |
| OA-P13 | Workers' Compensation Jurisdictional Regulation Adjustment | other | Review & Decide | → |
| OA-P14 | Benefit Included in Another Same-Day Service | other | Review & Decide | → |
| OA-P15 | Workers' Compensation Medical Treatment Guideline Adjustment | other | Review & Decide | → |
| OA-P16 | Provider Not Authorized to Treat Injured Workers | authorization | Verify & Resubmit | → |
| OA-P2 | Non-Work Related Injury/Illness | coverage | Resubmit | → |
| OA-P3 | Workers' Compensation Case Settled — Patient Responsibility | other | Review & Decide | → |
| OA-P4 | Workers' Compensation Claim Non-Compensable | other | Review & Decide | → |
| OA-P5 | Reasonable and Customary Fee Adjustment (No Legislated Maximum) | other | Review & Decide | → |
| OA-P6 | Benefits Entitlement Adjustment | other | Review & Decide | → |
| OA-P7 | Billed Code Not in Fee Schedule/Database | fee schedule | Review & Decide | → |
| OA-P8 | Claim Under Investigation | other | Review & Decide | → |
| OA-P9 | No CPT/HCPCS Code Available for Service | other | Review & Decide | → |