OA-142: Monthly Medicaid Patient Liability Amount
Adjustment in a COB or secondary payer context. Review the coordination of benefits details to determine the responsible party.
What Does OA-142 Mean?
When paired with Group Code OA, CARC 142 (Monthly Medicaid Patient Liability Amount) 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 142 appears on a remittance when the payer adjusts payment for the monthly medicaid patient liability amount. This is a standard plan-defined cost-sharing amount that the patient is obligated to pay per their insurance benefits. The code confirms the payer processed the claim correctly and applied the plan's benefit structure as designed.
Common scenarios that trigger this adjustment include: the Medicaid beneficiary has a monthly spend-down (patient liability) amount they must incur in medical expenses before Medicaid coverage begins. CARC 142 represents this patient liability portion.; The patient's income is above the Medicaid eligibility threshold, but they qualify under a medically needy or spend-down program. The liability amount equals the excess income that must be applied to medical costs.; For Medicaid long-term care beneficiaries, the patient's income (minus personal needs allowance) must be applied to the cost of care. CARC 142 reflects this monthly patient contribution.. The group code paired with CARC 142 determines who bears the financial responsibility — PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment, CO places it on the provider as a contractual obligation.
Common Causes
| Cause | Frequency |
|---|---|
| Informational reporting of patient liability OA is used to report the patient's Medicaid liability amount as an informational adjustment on the remittance | Most Common |
How to Resolve
- Review the coordination of benefits Examine the OA-142 adjustment to understand how it fits within the primary/secondary payer relationship or other multi-payer context.
- Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
- 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.
- 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.
- Follow up Monitor the claim status and take additional action as needed based on the COB determination.
Monthly Medicaid Patient Liability Amount grouped under OA is an Other Adjustment that doesn't fall into the standard contractual write-off or patient responsibility categories. Whether action is needed depends on the specific reason — review any accompanying RARC codes and payer guidance to decide whether this is a final adjustment to accept or an issue to resolve through resubmission.
How to Prevent OA-142
- Maintain accurate coordination of benefits information
- Verify secondary payer requirements before claim submission
Also Filed As
The same CARC 142 may appear with different Group Codes: