OA-171: Payment Denied for Provider Type in This Facility Type

What Does OA-171 Mean?

When paired with Group Code OA, CARC 171 (Payment Denied for Provider Type in This Facility Type) 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 171 indicates payment denied for provider type in this facility type. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the payer restricts certain services to specific provider type and facility type combinations, and the claim's combination is not among those authorized; The place of service code on the claim does not match the actual facility where the service was rendered, creating an ineligible provider/facility combination; The facility where the service was performed is not credentialed or authorized by the payer for the type of service billed. The group code paired with CARC 171 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-171 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-171

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

Also Filed As

The same CARC 171 may appear with different Group Codes:

Related Denial Codes