OA-P3: Workers' Compensation Case Settled — Patient Responsible via MSA

What Does OA-P3 Mean?

CARC P3 indicates the workers' compensation case has been legally settled, and the patient is now financially responsible for related medical expenses, typically through a Medicare Set-Aside (MSA) arrangement or structured settlement funds. The WC carrier is no longer liable for the claim.

When a WC case settles, a portion of the settlement may be designated as an MSA — funds set aside to cover future Medicare-covered medical expenses related to the work injury. The patient must use these funds for qualifying medical expenses before Medicare will begin covering them. Providers bill the MSA administrator or the patient directly for services related to the settled WC claim.

This is a legal settlement determination, not an appealable insurance denial. The WC carrier's liability ended per the terms of the settlement agreement.

How to Resolve

Verify the settlement terms, identify the MSA administrator or funding source, and collect from the patient or MSA.

1. Verify WC settlement status Confirm the WC case has been settled and understand the settlement terms.
2. Obtain MSA details Get the MSA administrator information, account details, and coverage terms from the patient or their attorney.
3. Bill the MSA or patient Submit claims to the MSA administrator for services related to the settled WC injury. Bill the patient directly if MSA funds are exhausted or no MSA exists.
4. Verify Medicare billing eligibility For Medicare patients, verify whether MSA funds are exhausted before billing Medicare for the related services.
5. Coordinate with patient's attorney If billing details are unclear, coordinate with the patient's WC attorney for settlement terms and payment procedures.

Also Filed As

The same CARC P3 may appear with different Group Codes:

Related Denial Codes