CARC 19 Active

OA-19: Workers' Compensation Claim

TL;DR

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

Action
Resubmit
Who Pays
Depends
Appeal
Yes
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-19 Mean?

When paired with Group Code OA, CARC 19 (Workers' Compensation Claim) 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 19 indicates workers' compensation claim. 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: claim for a work-related injury or illness was submitted to the patient's health insurance instead of the workers' compensation carrier; The payer's system flagged the diagnosis codes as work-related based on injury type or circumstance codes; The health plan determined another carrier (workers' comp) has primary liability for the services. The group code paired with CARC 19 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.

Common Causes

Cause Frequency
Liability redirect to workers' comp Health plan redirects claim to workers' compensation as the responsible payer Most Common

How to Resolve

  1. Review the coordination of benefits Examine the OA-19 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 Appeal with documentation proving the condition is not work-related if the classification was incorrect.
  5. Follow up Monitor the claim status and take additional action as needed based on the COB determination.
Appeal Guide

Appeal with documentation proving the condition is not work-related if the classification was incorrect.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-19:

RARC Description
N36 Claim must meet primary payer requirements before secondary payment Submit to workers' comp first →

How to Prevent OA-19

Also Filed As

The same CARC 19 may appear with different Group Codes:

CO-19 PR-19

Related Denial Codes

OA-20 — Liability Carrier Responsible OA-21 — No-Fault Carrier Responsible OA-22 — Coordination of Benefits - Another Payer May Cover OA-23 — Prior Payer Adjudication Impact OA-26 — Expenses Incurred Prior to Coverage

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://revenuecyclemgmt.com/claim-adjustment-reason-codes/
  3. https://www.rivethealth.com/blog/carcs-rarcs-claim-adjustment-remittance-advice-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.