What is OA in medical billing?
OA (Other Adjustments): It is used when no other group code applies to the adjustment.
PI (Payer Initiated Reductions): It is used by payers when it is believed the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and payer..
What are reason codes?
Reason codes, also called score factors or adverse action codes, are numerical or word-based codes that describe the reasons why a particular credit score is not higher. For example, a code might cite a high utilization rate of available credit as the main negative influence on a particular credit score.
What does OA mean on an EOB?
Other AdjustmentsCR = Corrections and Reversal. OA = Other Adjustments. PI = Payer Initiated Reductions. PR = Patient Responsibility. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I’s EOB codes.
What does PR 204 mean?
PR-204: This service/equipment/drug is not covered under the patient’s current benefit plan.
What does PR 22 mean?
Reason for Denial Secondary paymentPR 22 This care may be covered by another payer per coordination of benefits. Reason for Denial. Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
What does PR 96 mean?
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 PR 27 mean?
Expenses incurred after coverage terminatedPR-27: Expenses incurred after coverage terminated. • Claim Adjustment Reason Code (CARC) 26: Expenses incurred prior to coverage.
What is remark code n130?
Description. Reason Code: 109. Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor. Remark Code: N130.
What is duplicate denial?
A duplicate denial indicates more than one claim was submitted for the same service, for the same patient, for the same date of service. In most instances, the claim was already processed and paid or it is an exact duplicate of a previously submitted claim.
What does denial code OA 23 mean?
Code OA is used to identify this as an administrative adjustment.……. … Any further adjustment, taken by Medicare as a result of previous payer(s) payment and/or adjustment(s), with Group Code OA and Claim Adjustment Reason Code 23.
What is denial code oa23?
In that case secondary insurance will allow the difference between secondary allowable amount and primary paid amount as there net allowable amount and remaining balance they will deny with CO 23 Denial Code – The impact of prior payer(s) adjudication including payments and/or adjustments.
What does OA 121 mean?
Q4: What does the denial code OA-121 mean? A4: OA-121 has to do with an outstanding balance owed by the patient.