CARC 211 Active

OA-211: National Drug Codes (NDC) Not Eligible for Rebate, Not Covered

TL;DR

This is an informational adjustment about the NDC's rebate status. No action typically required.

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-211 Mean?

With OA (Other Adjustments), the non-rebatable NDC is reported as an informational adjustment. This typically does not require action beyond record-keeping.

CARC 211 indicates that the drug identified by the NDC on the claim is not eligible for coverage because the manufacturer has not participated in the required drug rebate program. For Medicaid, this means the drug manufacturer has not signed a Medicaid Drug Rebate Agreement, making the drug ineligible for Medicaid coverage. For other federal programs, the drug may not be listed in the Federal Supply Schedule.

This denial can also occur when the wrong NDC was submitted (a data entry error), when a brand-name NDC was billed instead of a covered generic equivalent, or when the drug product has been removed from the rebate program. The resolution depends on whether the correct NDC was submitted and whether a covered alternative exists.

Common Causes

Cause Frequency
Informational adjustment for non-rebatable NDC The payer reports the non-rebatable status as an informational adjustment Common

How to Resolve

  1. Record the adjustment Log the adjustment for accounting and reporting purposes.
Do Not Appeal This Code

This is an informational adjustment indicating the NDC is not eligible for drug rebate. No appeal is typically warranted for OA adjustments.

How to Prevent OA-211

Also Filed As

The same CARC 211 may appear with different Group Codes:

CO-211 PR-211

Related Denial Codes

OA-19 — Workers' Compensation Claim 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

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. 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
  3. https://www.aapc.com/resources/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.