835 Denial Combination
OA-2
Other Adjustment · Claim-Level Adjustment
Patient ResponsibilityWhat This Combination Means
This combination indicates a coinsurance amount that is not the patient's responsibility due to coordination of benefits or third-party liability. The OA group code overrides the typical patient responsibility nature of coinsurance, signaling that another payer or entity is responsible for this portion. This typically appears when a primary payer has paid and the coinsurance is being transferred to a secondary payer, workers compensation carrier, or other liable party.
Financial Responsibility
other payer
The coinsurance amount is owed by another insurance carrier or third-party entity, not the patient or provider. This occurs in coordination of benefits scenarios where the secondary or tertiary payer should cover the coinsurance portion.
N/A
Appeal Success
Immediate (bill other payer)
Avg. Resolution
Easy
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this OA-2 combination — not generic advice.
- 1
Identify the responsible payer
Review the ERA/EOB for coordination of benefits information indicating which secondary payer, workers compensation carrier, or other entity is responsible for the coinsurance amount.
- 2
Bill the identified secondary or other payer
Submit a claim to the appropriate payer with the primary payer's EOB attached showing the coinsurance amount transferred under OA-2.
- 3
Update patient account records
Document that the coinsurance is billed to the other payer and is not patient-owed to prevent inappropriate balance billing.
Specialty Context
How OA-2 typically presents across different practice types.
Dental
Common when dental claims involve coordination with medical insurance for accident-related treatment or when workers compensation is the liable party for workplace injuries.
Medical
Frequently seen in coordination of benefits between multiple health plans, Medicare supplemental scenarios, or when auto insurance or workers compensation is primary for accident or injury-related care.
Behavioral Health
May appear when behavioral health services coordinate between medical and behavioral health plans, or when services relate to workers compensation or third-party liability situations.
Individual Code References
View the standalone definition for each code in this combination.
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