OA-224: Patient Identification Compromised by Identity Theft

What Does OA-224 Mean?

With OA (Other Adjustments), the identity concern was flagged during coordination of benefits. Verify the patient's identity and resubmit.

CARC 224 indicates that the payer has identified a potential identity theft issue with the patient's insurance information. The patient's identification may have been reported as compromised, flagged for suspicious activity, or involved in known fraud schemes. The payer cannot process the claim until the identity is verified.

This code protects patients from fraudulent use of their insurance information and protects payers from paying fraudulent claims. Resolution requires working with the patient and payer to verify the patient's identity and ensure the claim is legitimate.

Common Causes

How to Resolve

1. Verify identity Confirm the patient's identity with the flagging payer.
2. Resubmit Submit the verified claim.

How to Prevent OA-224

• Verify patient identity for all payers in the COB chain

General Prevention

• Maintain identity verification records for all patients
• Respond promptly to identity theft alerts from payers

Also Filed As

The same CARC 224 may appear with different Group Codes:

Related Denial Codes