CARC 279 Active

OA-279: Services Not Provided by Preferred Network Providers

TL;DR

OA-279: This adjustment involves secondary payer processing or coordination of benefits. Review the COB arrangement and primary payer adjudication to determine the appropriate action.

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-279 Mean?

When paired with Group Code OA, CARC 279 typically appears in a secondary payer or coordination of benefits context. The adjustment for services not provided by preferred network providers is being processed through COB rules. The financial responsibility depends on the specific coordination arrangement between payers.

CARC 279 indicates that the services billed were rendered by a provider who is not part of the patient's preferred or narrow network tier. This is distinct from a simple out-of-network denial — it specifically targets plans with multiple network tiers where the provider may be contracted with the payer but is not in the patient's specific preferred tier.

The financial impact depends on the Group Code. Under CO, the provider absorbs the cost difference because they are not in the preferred tier — this is common with tiered network plans where contracted providers receive different reimbursement levels. Under PR, the patient is responsible because they chose to receive services from a non-preferred provider, and the cost difference or full charge is their obligation.

This code has become more common as payers expand tiered network designs and narrow network products. A provider who was previously in a broad network may find themselves outside a patient's narrow or preferred tier, triggering this denial even though they still have a contract with the payer.

How to Resolve

  1. Review the coordination of benefits Examine the OA-279 adjustment and determine how it fits within the primary/secondary payer relationship.
  2. Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
  3. Determine appropriate action Based on the COB review, decide whether to accept the adjustment, submit additional documentation, or file an appeal with the secondary payer.
  4. Follow up Monitor the claim and take additional action as needed based on the COB determination.
Do Not Appeal This Code

Services Not Provided by Preferred Network Providers grouped under OA is an Other Adjustment that doesn't fall into the standard contractual write-off or patient responsibility categories. Whether action is needed depends on the specific reason — review any accompanying RARC codes and payer guidance to decide whether this is a final adjustment to accept or an issue to resolve through resubmission.

How to Prevent OA-279

Also Filed As

The same CARC 279 may appear with different Group Codes:

CO-279 PR-279

Related Denial Codes

OA-74 — Indirect Medical Education Adjustment OA-75 — Direct Medical Education Adjustment OA-76 — Disproportionate Share Adjustment OA-85 — Patient Interest Adjustment OA-89 — Professional Fees Removed from Charges

Sources

  1. https://www.mdclarity.com/denial-code/279
  2. https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.