OA-296: Precertification/Authorization Number Does Not Apply to Provider

What Does OA-296 Mean?

When CARC 296 appears with OA, the payer is flagging the authorization mismatch without clearly assigning financial responsibility. This may occur during coordination of benefits or when the payer is reviewing the authorization and has not yet made a final determination on liability.

When CARC 296 appears on your remittance, the payer is telling you that the precertification, authorization, notification, or pre-treatment number you submitted with the claim is technically valid in their system, but it is not associated with your provider record. The authorization exists, but it was issued for a different provider than the one who billed the claim.

This situation commonly arises when a patient receives an authorization through one provider but then receives treatment from a different provider. For example, a PCP may obtain a precertification for a procedure, but the patient sees a specialist whose NPI is different from the one on the authorization. It also occurs when a provider changes practice locations, merges with another group, or when the authorization was obtained under a group NPI but billed under an individual NPI.

Unlike codes that indicate no authorization exists, CARC 296 confirms the authorization is valid. The issue is purely a mismatch between the authorized provider and the billing provider. This distinction is important because it means the service was already deemed medically appropriate by the payer, and the fix typically involves correcting the provider association rather than obtaining entirely new authorization.

How to Resolve

Identify the provider mismatch, obtain a corrected authorization, and resubmit the claim.

1. Clarify liability and authorization status Contact the payer to determine the next steps for correcting the authorization and clarify who bears financial responsibility.
2. Correct and resubmit Once the authorization is updated, resubmit the claim with the corrected information.

How to Prevent OA-296

• Verify authorization provider assignment before claim submission
• Maintain clear records of all authorization numbers and their associated provider NPIs

Also Filed As

The same CARC 296 may appear with different Group Codes:

Related Denial Codes