OA-142: Monthly Medicaid Patient Liability Amount

What Does OA-142 Mean?

OA-142 may appear when the liability adjustment is informational or when the claim is processed during a transition in the patient's eligibility period. The practical handling is similar to PR — verify the liability status and ensure the spend-down is satisfied.

CARC 142 is a Medicaid-specific code that appears when the state Medicaid agency has assigned a monthly liability (also called spend-down) to the patient. Medicaid spend-down works like a deductible — the patient must incur medical expenses up to a specified amount each month before Medicaid begins paying. The monthly liability amount is determined by the state based on the patient's income and household size, and it resets each eligibility period.

When CARC 142 appears on the remittance, the payer is telling you that the patient's Medicaid coverage is conditional on meeting their spend-down obligation, and the patient has not yet satisfied that requirement for the service period. The adjusted amount represents the patient's liability — the portion the patient must pay out of pocket. Once the spend-down is met (through payments to your practice or other providers), Medicaid will cover the remaining eligible services.

This code most commonly appears with Group Code PR, reflecting that the adjusted amount is the patient's direct financial responsibility. The key workflow consideration is timing — the patient may be meeting their spend-down with multiple providers simultaneously, so coordinating with the Medicaid agency to track the liability balance is important. Collecting the liability amount at the time of service, when possible, simplifies the process and reduces the chance of resubmission delays.

How to Resolve

Verify the patient's Medicaid spend-down status, collect the liability amount from the patient, and resubmit to Medicaid once the spend-down is satisfied.

1. Verify eligibility and liability Check the patient's current Medicaid eligibility status and monthly liability amount with the state agency.
2. Resolve and resubmit Ensure the spend-down is satisfied, then resubmit the claim for processing.

How to Prevent OA-142

• Verify Medicaid eligibility and spend-down status before each visit
• Maintain communication with the state Medicaid agency about patient liability balances

Also Filed As

The same CARC 142 may appear with different Group Codes:

Related Denial Codes