OA-223: Mandated Federal/State/Local Law Adjustment

What Does OA-223 Mean?

With OA (Other Adjustments), the legislated adjustment was applied during coordination of benefits.

CARC 223 indicates that the payment adjustment was mandated by legislation or regulation rather than by the payer's own policies. This can include adjustments required by the Affordable Care Act, state insurance regulations, Medicaid rate mandates, workers compensation fee schedules set by law, or other legislative requirements that affect healthcare payment.

This code is informational in nature — it tells the provider that the adjustment is not the payer's discretionary decision but rather a compliance requirement with applicable law. The specific law or regulation driving the adjustment may be identified in accompanying remark codes.

Common Causes

How to Resolve

1. Verify the adjustment Confirm the legislated adjustment is correct.
2. Accept or contest Accept if correct, or contest if the law was misapplied.

How to Prevent OA-223

• Verify legislated adjustments apply correctly across all payers in the COB chain

General Prevention

• Monitor regulatory changes that may affect adjustments across all payers

Also Filed As

The same CARC 223 may appear with different Group Codes:

Related Denial Codes