OA-215: Based on Subrogation of a Third Party Settlement

What Does OA-215 Mean?

With OA (Other Adjustments), the subrogation adjustment appeared during coordination of benefits. Review the settlement and COB details.

CARC 215 indicates that the payer's payment was reduced or denied because a third-party settlement (such as an auto insurance settlement, workers compensation settlement, or personal injury settlement) includes funds designated for the medical expenses billed on this claim. The payer is exercising its subrogation rights to recover or reduce payment because the patient has already received compensation for these services from another source.

Subrogation is the legal right of the insurance company to seek reimbursement from a third party that caused the injury or from settlement funds designated for medical costs. This is common in auto accident cases, slip-and-fall injuries, and workers compensation claims where a third party is financially responsible.

Common Causes

How to Resolve

1. Review COB and settlement details Understand how the settlement affects payment across multiple payers.
2. Submit to the correct payer Direct the claim to the appropriate payer based on the settlement terms.

How to Prevent OA-215

• Coordinate subrogation claims across all payers in the COB chain

General Prevention

• Identify and document third party liability early in the claims process
• Coordinate billing across all involved payers

Also Filed As

The same CARC 215 may appear with different Group Codes:

Related Denial Codes