OA-B1: Non-Covered Visits

What Does OA-B1 Mean?

When paired with Group Code OA, the non-coverage determination was made during coordination of benefits processing. The visits may be covered by a different payer. Verify which payer should cover the visits and redirect the claim if necessary.

CARC B1 indicates that the billed visits or services are not covered by the patient's insurance plan. This is a broad non-coverage denial that can stem from multiple causes: the visit type may be explicitly excluded from the plan, the patient may have exhausted their allowed number of visits for the benefit period, required prior authorization was not obtained, the provider is out of network, or the payer determined the visits were not medically necessary.

The resolution path depends on the specific reason for non-coverage. If the visits are genuinely excluded from the plan, there is limited recourse. If the denial resulted from missing authorization, coding errors, or incorrect benefit tracking, correcting the issue and resubmitting or appealing is appropriate. If medical necessity is contested, a clinical appeal with physician documentation is the appropriate path.

Common Causes

How to Resolve

1. Review COB details Determine which payer should cover the visit type.
2. Redirect if misdirected Submit the claim to the appropriate payer.
3. Appeal if incorrect If the non-coverage determination is wrong, appeal with COB documentation and clinical records.

How to Prevent OA-B1

• Verify COB details and confirm which payer covers the visit type
• Submit claims to the correct payer based on COB determination

Also Filed As

The same CARC B1 may appear with different Group Codes:

Related Denial Codes