CARC 183 Active

OA-183: Referring Provider Not Eligible to Refer

TL;DR

The referring provider issue was flagged during coordination of benefits. Resolve the provider's eligibility and resubmit.

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-183 Mean?

With OA (Other Adjustments), the referring provider eligibility issue was flagged during coordination of benefits. The referral provider's status must be resolved before any payer in the COB chain can process the claim.

CARC 183 indicates that the referring provider listed on the claim does not meet the payer's requirements for making referrals. This could mean the referring provider is not enrolled with the payer, their NPI is invalid or inactive, their specialty is not authorized to make referrals for the billed service, or they have been excluded from federal healthcare programs.

This code is common for services that require a physician referral, such as specialist consultations, physical therapy, and certain diagnostic tests. The payer validates the referring provider's status during claim processing and rejects the claim if the referral source is not eligible. Resolving this requires verifying and correcting the referring provider's information.

How to Resolve

  1. Identify which payer flagged the issue Review the remittance to determine which payer in the COB chain identified the ineligible referring provider.
  2. Resolve the provider's eligibility Correct the NPI, obtain a new referral, or appeal as appropriate.
  3. Resubmit through the COB sequence Submit the corrected claim through the proper payer priority order.
Do Not Appeal This Code

Referring Provider Not Eligible to Refer 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-183

Also Filed As

The same CARC 183 may appear with different Group Codes:

CO-183 PR-183

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/183
  2. https://x12.org/codes/claim-adjustment-reason-codes
  3. 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
  4. https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/R743CP.PDF
  5. Codes maintained by X12. Visit x12.org for official definitions.