CARC 206 Active

OA-206: National Provider Identifier - Missing

TL;DR

The NPI was missing on the COB claim. Add the NPI and resubmit.

Action
Verify & Resubmit
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-206 Mean?

With OA (Other Adjustments), the missing NPI was flagged during coordination of benefits. Add the NPI and resubmit to the secondary payer.

CARC 206 indicates that one or more NPI fields on the claim were left blank. Claims require NPIs for various provider roles — billing provider, rendering provider, referring provider, and ordering provider — depending on the service type. The payer's system could not match the claim to a provider because the NPI field was empty.

This is a data entry issue, not a coverage or medical necessity denial. The fix is straightforward: add the missing NPI to the correct field and resubmit the claim. This code frequently affects claims for services that require an ordering or referring provider NPI, such as laboratory work, imaging, and DME.

Common Causes

Cause Frequency
NPI missing in coordination of benefits submission The NPI was not included when the claim was forwarded to a secondary payer Common

How to Resolve

  1. Add the missing NPI Enter the correct NPI on the claim.
  2. Resubmit to the secondary payer Submit the corrected claim.
Do Not Appeal This Code

The NPI was missing from the claim. Add the missing NPI and resubmit the claim to the secondary payer.

How to Prevent OA-206

Also Filed As

The same CARC 206 may appear with different Group Codes:

CO-206 PR-206

Related Denial Codes

OA-16 — Missing Information or Billing Error OA-146 — Diagnosis Invalid for Date of Service OA-148 — Information from Another Provider Not Provided or Incomplete OA-175 — Prescription Is Incomplete OA-181 — Procedure Code Invalid on Date of Service

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/206
  3. https://med.noridianmedicare.com/web/jeb/topics/claim-submission/reason-code-guidance/missing-incorrect-req-npi-info
  4. Codes maintained by X12. Visit x12.org for official definitions.