OA-174: Service Not Prescribed Prior to Delivery

What Does OA-174 Mean?

When paired with Group Code OA, CARC 174 (Service Not Prescribed Prior to Delivery) 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 174 relates to service not prescribed prior to delivery. The payer requires specific authorization, certification, or referral for this service, and the claim was adjusted because that requirement was not satisfied.

Common scenarios that trigger this adjustment include: the physician's order or prescription was obtained after the service was already delivered, and the payer requires the order to be in place before the service is performed; The provider obtained a retroactive physician's order but the payer does not accept retroactive prescriptions for this type of service; The service was provided on an emergency basis without a prior prescription, but the payer does not recognize the emergency exception or documentation was insufficient. The group code paired with CARC 174 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment.

How to Resolve

1. Review the coordination of benefits Examine the OA-174 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-174

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

Also Filed As

The same CARC 174 may appear with different Group Codes:

Related Denial Codes