CARC 39 Active

OA-39: Services Denied at Authorization/Pre-certification

TL;DR

Adjustment in a COB or secondary payer context. Review the coordination of benefits details to determine the responsible party.

Action
Appeal
Who Pays
Depends
Appeal
Yes
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-39 Mean?

With OA (Other Adjustments), CARC 39 typically appears in a coordination of benefits (COB) context. Secondary payer denied authorization for the service. The financial responsibility depends on the specific arrangement between payers — review the primary payer's EOB and the COB terms to determine the correct course of action.

CARC 39 relates to services denied at authorization/pre-certification. The payer requires specific authorization, certification, or referral for this service, and the claim was adjusted because that requirement was not satisfied.

Common scenarios that trigger this adjustment include: the payer denied the authorization request for the service before it was performed; The payer determined the service was not medically necessary during the pre-certification review; The authorization request lacked sufficient clinical information to justify the service. The group code paired with CARC 39 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment.

Common Causes

Cause Frequency
Secondary payer authorization denial Secondary payer denied authorization for the service Most Common

How to Resolve

  1. Review the coordination of benefits Examine the OA-39 adjustment to understand how it fits within the primary/secondary payer relationship or other multi-payer context.
  2. Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
  3. Determine the responsible party Based on the COB review, identify whether the adjustment should be absorbed, billed to another payer, or if additional documentation is needed.
  4. Appeal or resubmit if needed Appeal with clinical documentation supporting medical necessity.
  5. Follow up Monitor the claim status and take additional action as needed based on the COB determination.
Appeal Guide

Appeal with clinical documentation supporting medical necessity.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-39:

RARC Description
M62 Missing/incomplete/invalid treatment authorization Obtain authorization from secondary payer →

How to Prevent OA-39

Also Filed As

The same CARC 39 may appear with different Group Codes:

CO-39 PR-39

Related Denial Codes

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 OA-243 — Services Not Authorized by Network/Primary Care Providers

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/39
  3. https://www.patientstudio.com/pr-39-denial
  4. Codes maintained by X12. Visit x12.org for official definitions.