OA-118: ESRD Network Support Adjustment

What Does OA-118 Mean?

When paired with Group Code OA, CARC 118 (ESRD Network Support Adjustment) is processed as an adjustment outside the standard CO/PR classifications. This typically occurs in secondary payer or coordination of benefits scenarios. Review the remittance details and the COB arrangement to determine financial responsibility and appropriate next steps.

CARC 118 means the payer adjusted the payment based on esrd network support adjustment. The reimbursement was calculated using the payer's fee schedule, contracted rate, or regulatory payment methodology rather than the billed charge.

Common scenarios that trigger this adjustment include: medicare deducts a per-treatment amount from ESRD facility payments to fund the ESRD Network Organizations that oversee quality of care for dialysis patients. CARC 118 reflects this standard deduction.; The per-treatment network support deduction rate was updated by CMS, and the new rate is reflected in the payment adjustment. The group code paired with CARC 118 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

How to Resolve

1. Review the coordination of benefits Examine the OA-118 adjustment to understand how it fits within the primary/secondary payer relationship or other multi-payer context.
2. Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
3. Determine the responsible party Based on the COB review, identify whether the adjustment should be absorbed, billed to another payer, or if additional documentation is needed.
4. Appeal or resubmit if needed If the OA adjustment appears incorrect based on the COB arrangement, submit an appeal or corrected claim with the appropriate documentation.
5. Follow up Monitor the claim status and take additional action as needed based on the COB determination.

How to Prevent OA-118

• Maintain accurate coordination of benefits information
• Verify secondary payer requirements before claim submission

Also Filed As

The same CARC 118 may appear with different Group Codes:

Related Denial Codes