CARC 164 Active

OA-164: Attachment/Documentation Not Received in Timely Fashion

TL;DR

Adjustment in a COB or secondary payer context. Review the coordination of benefits details to determine the responsible party.

Action
Review & Decide
Who Pays
Depends
Appeal
No
Patient Impact
Indirect
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does OA-164 Mean?

When paired with Group Code OA, CARC 164 (Attachment/Documentation Not Received in Timely Fashion) 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 164 indicates attachment/documentation not received in timely fashion. The payer rejected the claim because it was not received within the required filing deadline specified by the payer's guidelines or the provider contract.

Common scenarios that trigger this adjustment include: the required supporting documentation was submitted after the payer's specified timeframe for receiving attachments, resulting in the claim being denied; The payer requested additional documentation (ADR) and the provider did not respond within the required timeframe; The attachment was mailed or faxed separately from the claim and arrived after the payer's processing deadline. The group code paired with CARC 164 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-164 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.
Do Not Appeal This Code

Attachment/Documentation Not Received in Timely Fashion 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-164

Also Filed As

The same CARC 164 may appear with different Group Codes:

CO-164 PR-164

Related Denial Codes

OA-74 — Indirect Medical Education Adjustment OA-75 — Direct Medical Education Adjustment OA-76 — Disproportionate Share Adjustment OA-85 — Patient Interest Adjustment OA-89 — Professional Fees Removed from Charges

Sources

  1. https://www.mdclarity.com/denial-code/164
  2. https://www.codingahead.com/denial-code-164/
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
  5. Codes maintained by X12. Visit x12.org for official definitions.