CARC 284 Active

OA-284: Authorization Valid But Does Not Apply to Billed Services

TL;DR

OA-284: 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-284 Mean?

When paired with Group Code OA, CARC 284 typically appears in a secondary payer or coordination of benefits context. The adjustment for authorization valid but does not apply to billed services is being processed through COB rules. The financial responsibility depends on the specific coordination arrangement between payers.

CARC 284 indicates that the precertification, authorization, notification, or pre-treatment number provided on the claim may be valid — meaning it exists in the payer's system — but it does not cover the specific services that were billed. The authorization was issued for different procedures, different dates of service, a different provider, or a different scope of treatment than what appears on the claim.

This is a nuanced denial because the provider did obtain authorization, just not the right one for the billed services. Common scenarios include: using an authorization that covers some but not all of the billed procedure codes, submitting a claim for services performed after the authorization expired, billing additional procedures beyond what was originally approved, or simply entering the wrong authorization number due to a clerical error.

The distinction between CARC 284 and a standard no-authorization denial (such as CARC 197) is important: with 284, the payer acknowledges an authorization exists but identifies a mismatch between that authorization and the claim. This typically means the fix is achievable — either locate the correct authorization number, request retroactive authorization, or demonstrate that the existing authorization should cover the billed services.

How to Resolve

  1. Review the coordination of benefits Examine the OA-284 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

Authorization Valid But Does Not Apply to Billed Services reflects an authorization or referral issue. The standard path is not an appeal but a request for retroactive authorization through the payer's process — appeals only apply when authorization was obtained but the payer failed to record it. Gather the authorization documentation if available; otherwise the adjustment usually stands.

How to Prevent OA-284

Also Filed As

The same CARC 284 may appear with different Group Codes:

CO-284 PR-284

Related Denial Codes

OA-39 — Services Denied at Authorization/Pre-certification OA-61 — Failure to Obtain Second Surgical Opinion OA-197 — Precertification/Authorization/Notification Absent OA-198 — Precertification/Authorization Limits Exceeded OA-210 — Pre-Certification/Authorization Not Received Timely

Sources

  1. https://www.mdclarity.com/denial-code/284
  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.