OA-170: Payment Denied — Provider Type Not Eligible

What Does OA-170 Mean?

OA-170 appears infrequently and typically in coordination of benefits situations where the provider type restriction applies differently across the patient's multiple payers. The OA designation suggests the adjustment may be recoverable from another payer.

When CARC 170 appears on a remittance, the payer has denied the claim because the type of provider who performed or billed the service is not authorized to receive payment for that specific procedure. This is not a question about whether the service was medically necessary or properly coded — the payer is saying that the provider's credentials, specialty, or enrollment status does not qualify them to bill this particular CPT or HCPCS code.

Payers maintain lists of which provider types are authorized for specific services. A nurse practitioner may be able to bill evaluation and management codes but not certain surgical procedures. A physical therapist may be restricted from billing certain diagnostic services. These restrictions vary significantly between payers and are often rooted in state scope-of-practice laws, payer contracts, and Medicare's provider type requirements. The RARC most frequently paired with this code is N95 ('This provider type/provider specialty may not bill this service'), which confirms the provider-type mismatch.

The most common resolution involves correcting the billing to use the right provider's NPI. In many cases, the service was legitimately provided but billed under the wrong provider — for example, a mid-level provider billed independently when the service should have been billed incident-to a supervising physician. In other cases, the rendering provider's enrollment with the payer may need to be updated to reflect the correct specialty or credentials. Always check the 835 Loop 2110 REF Healthcare Policy Identification Segment, which points you directly to the payer policy that triggered the denial.

How to Resolve

Identify the provider type restriction, verify credentials and enrollment, and either correct the billing identifiers or rebill under an eligible provider.

1. Check secondary payer eligibility Verify whether the secondary payer recognizes the provider type for this service.
2. Submit to the secondary payer If the secondary payer covers the service from this provider type, submit the claim with the primary payer's EOB.
3. Request reprocessing if OA was applied in error If no coordination issue exists, contact the payer to request the claim be reprocessed.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-170:

How to Prevent OA-170

• Verify provider type eligibility with all patient payers during the eligibility check
• Document which payer covers services from each provider type in the patient's account

Also Filed As

The same CARC 170 may appear with different Group Codes:

Related Denial Codes