OA-147: Provider Accepted Reduced Payment from Regulatory Authority

What Does OA-147 Mean?

When paired with Group Code OA, CARC 147 (Provider Accepted Reduced Payment from Regulatory Authority) 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 147 appears on a remittance when the payer applies an adjustment for provider accepted reduced payment from regulatory authority. Review the group code and any accompanying RARC codes to understand the full context of this adjustment.

Common scenarios that trigger this adjustment include: the provider has accepted payment from a state or federal regulatory authority for the same service, and the payer is denying or reducing the claim to avoid duplicate payment; The provider received payment from workers' compensation, state fund, or another government regulatory program for this service, making the commercial claim ineligible for additional payment; The provider agreed to a reduced rate through a regulatory authority's settlement or negotiation process, and the payer applies this reduced amount. The group code paired with CARC 147 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-147 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-147

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

Also Filed As

The same CARC 147 may appear with different Group Codes:

Related Denial Codes