835 Denial Combination
OA-1
Other Adjustment · Claim-Level Adjustment
Patient ResponsibilityWhat This Combination Means
This combination indicates a deductible amount is being reported under OA rather than the typical PR group code. The OA group signals this deductible applies to coordination of benefits, workers compensation, or another third-party liability scenario rather than the patient's standard health insurance deductible. The amount should be billed to the appropriate secondary payer or other liable party, not collected from the patient.
Financial Responsibility
other payer
The deductible amount is owed by a secondary payer, workers compensation carrier, or other third-party liable entity, not the patient or provider. This represents a transfer of liability in a coordination of benefits scenario.
N/A
Appeal Success
7-14 days (secondary billing)
Avg. Resolution
Medium
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this OA-1 combination — not generic advice.
- 1
Identify the liable third party from the remittance advice
OA group code indicates COB, workers comp, or other third-party liability — determine which entity owes the deductible amount
- 2
Bill the identified secondary payer or liable entity for the deductible amount
Submit claim with primary payer's EOB showing OA-1 adjustment to establish the deductible obligation under coordination of benefits
- 3
Document the adjustment and monitor secondary payer response
Track the transferred liability separately from patient responsibility to ensure proper payment from the appropriate entity
Specialty Context
How OA-1 typically presents across different practice types.
Dental
Common in scenarios where medical insurance is primary for accident-related dental injuries and dental plan is secondary, with deductible applied at primary level.
Medical
Frequently appears when Medicare is secondary to workers compensation, auto insurance, or liability coverage, with deductible amounts transferred to the primary liable party.
Behavioral Health
Seen when substance abuse or mental health services involve coordination between behavioral health carve-out plans and medical plans, with deductible responsibility shifting between payers.
Individual Code References
View the standalone definition for each code in this combination.
Need to resolve this denial?
Get a complete resolution plan with appeal guidance for this exact combination in seconds.
Generate a free resolution plan & appeal letter →Synthesized from official definitions — not from training data