CARC 245 Active

OA-245: Provider Performance Program Withhold

TL;DR

OA-245 is an informational report of the performance withhold amount. Track it across all payer contracts for reconciliation.

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-245 Mean?

When paired with Group Code OA, the performance program withhold is reported as an informational adjustment. This typically appears in coordination of benefits scenarios or when the payer is reporting the withhold amount for tracking purposes without attributing it to a specific party's obligation.

CARC 245 indicates that the payer is withholding a portion of the claim payment as part of a provider performance program established in your contract. This is not a denial or an error — it is a contractual mechanism where the payer sets aside a percentage of each payment, with the potential to return some or all of the withheld amount based on your performance on quality metrics.

These programs go by various names: pay-for-performance, value-based payment arrangements, shared savings programs, and risk-sharing agreements. The common thread is that the payer holds back a defined percentage and ties its return to measurable outcomes such as patient satisfaction scores, readmission rates, preventive care compliance, or cost efficiency targets.

The withheld amount is not lost revenue — it is contingent revenue. Providers who meet or exceed the performance targets may receive the full withhold back, and in some programs, earn additional incentive payments. Providers who fall short of targets may forfeit part or all of the withheld amount.

Common Causes

Cause Frequency
Informational performance withhold reporting The withhold amount is reported as an OA informational adjustment Common

How to Resolve

  1. Review the informational withhold amount Note the withheld amount reported under OA and add it to your tracking for this payer's performance program.
  2. Track against performance expectations Verify the OA-245 amount is consistent with the contracted withhold terms and your expected performance period totals.
Do Not Appeal This Code

This is an informational report of the performance program withhold amount. No appeal is needed.

How to Prevent OA-245

General Prevention

Also Filed As

The same CARC 245 may appear with different Group Codes:

CO-245 PR-245

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.