CARC 212 Active

OA-212: Administrative Surcharges Not Covered

TL;DR

Administrative surcharges were flagged during COB. Remove 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-212 Mean?

With OA (Other Adjustments), the administrative surcharge was flagged during coordination of benefits. Remove the surcharge and resubmit.

CARC 212 indicates that the claim includes charges classified as administrative surcharges rather than medical services. These can include late payment penalties, administrative processing fees, convenience charges, or other non-clinical fees that payers do not recognize as covered services. Insurance plans typically cover only medically necessary services and do not reimburse for administrative add-on charges.

Common Causes

Cause Frequency
Informational adjustment for non-covered surcharge The payer reports the non-covered administrative surcharge as an informational OA adjustment Common

How to Resolve

  1. Remove surcharges Remove administrative charges from the claim.
  2. Resubmit Submit the corrected claim.
Do Not Appeal This Code

This is an informational adjustment for a non-covered administrative surcharge. No appeal is warranted.

How to Prevent OA-212

General Prevention

Also Filed As

The same CARC 212 may appear with different Group Codes:

CO-212 PR-212

Related Denial Codes

OA-24 — Charges Covered Under Capitation/Managed Care OA-44 — Prompt-Pay Discount OA-45 — Charge Exceeds Fee Schedule/Maximum Allowable OA-69 — Day Outlier Amount OA-70 — Cost Outlier Adjustment

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.