OA-200: Expenses Incurred During Lapse in Coverage

What Does OA-200 Mean?

With OA (Other Adjustments), the coverage lapse was identified during coordination of benefits. One payer found the patient had no active coverage during the service period. Check if another payer in the COB chain covers the service.

CARC 200 indicates that the patient did not have active insurance coverage during the period when the service was rendered. The coverage may have lapsed due to non-payment of premiums, terminated due to job loss or aging out, or the service may have fallen in a gap between two coverage periods.

This code differs from general eligibility denials because it specifically identifies a lapse period — a time when coverage should have been or previously was active but was not on the specific date of service. It can also appear when incorrect or outdated insurance information was submitted, making it appear the patient had no coverage when they actually did.

Common Causes

How to Resolve

1. Review COB details Determine which payer identified the lapse and whether another payer has active coverage for the service date.
2. Submit to the payer with active coverage If another payer covers the service, submit the claim accordingly.
3. Appeal if coverage was active If coverage was active with this payer, submit proof and request reprocessing.

How to Prevent OA-200

• Verify coordination of benefits and coverage dates for all payers before service
• Maintain accurate records of all active payers for each patient

Also Filed As

The same CARC 200 may appear with different Group Codes:

Related Denial Codes