What is OA 23 Adjustment code mean?

OA-23: Indicates the impact of prior payers(s) adjudication, including payments and/or adjustments. No action required since the amount listed as OA-23 is the allowed amount by the primary payer. OA-109: Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

What is denial code OA 18?

A: You will receive this reason code when more than one claim has been submitted for the same item or service(s) provided to the same beneficiary on the same date(s) of service. …

What does OA 133 mean?

133 The disposition of the claim/service is pending further review. (Use only with Group Code OA). Note: Use of this code requires a reversal and correction when the service line is finalized ( use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837). 134 Technical fees removed from charges.

What does PR 204 mean?

PR-204: This service/equipment/drug is not covered under the patient’s current benefit plan.

What does OA mean in insurance?

Other Adjustments
OA (Other Adjustments) is used when CO (Contractual Obligation) nor PR (Patient Responsibility apply. This can be used when the claim is paid in full and there is no contractual obligation or patient responsibility on the claim.

What does PR 227 mean?

227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.

What does PR 187 mean?

187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.) 188 This product/procedure is only covered when used according to FDA recommendations.

What does PR 96 mean?

Patient Related Concerns
PR 96 Denial Code: Patient Related Concerns When a patient meets and undergoes treatment from an Out-of-Network provider. Based on Provider’s consent bill patient either for the whole billed amount or the carrier’s allowable.

What does OA mean in a group code?

Group code OA is used when neither PR nor CO applies, such as with the reason code message that indicates the bill is being paid in full.

What does OA 23 followed by an adjustment amount mean?

What does code OA 23 followed by an adjustment amount mean? This code is used to standardize the way all payers report coordination of benefits (COB) information. Whenever COB applies, this code combination is used to represent the prior payer’s impact fee or sum of all adjustments and payments affecting the amount BCBSF will pay.

What does OA mean in medical billing?

• OA (Other Adjustment). • CR (Correction or Reversal to a prior decision). Group Code PR. All denials or reductions from the billed amount with group code PR are the financial responsibility of the beneficiary or his supplemental insurer (if it covers that service).

What is the difference between OA 253 and OA 254?

(Use only with Group Code OA) Reason Code 253: Service not payable per managed care contract. Reason Code 254: The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements.