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: 205 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 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
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Other Group Codes

CO
Contractual Obligation
PI
Payor Initiated Reduction
PR
Patient Responsibility