What does denial code OA-22 mean?

OA-22 means: The service you received might be covered by another insurance plan you have. The payer needs you to check whether a different insurance should pay first.. This care may be covered by another payer per coordination of benefits. This denial was received because Medicare records indicate that Medicare is the secondary payer.

How do I resolve a OA-22 denial?

Refer to the patient's file and review the MSP questionnaire if it was previously completed. Contact the patient or patient representative and ask if insurance has changed. The MSP Questionnaire may be completed again to help determine if Medicare is the secondary payer. See full Medicare contractor resolution steps at tryarceum.com.

Can I appeal a OA-22 denial?

OA-22 denials are generally not appealable. This is an administrative issue requiring coordination of benefits information rather than a coverage determination that can be appealed.

CARC Code

22

🟡 Soft Denial

Other Payer May Cover

The service you received might be covered by another insurance plan you have. The payer needs you to check whether a different insurance should pay first.

cob

Resolution: 78%Medium difficulty14-30 days avg

How to resolve this denial

Which payer denied this claim?

▶✓ Pre-action checklist — verify before contacting the payer

Does the patient have other active insurance coverage?
Was the correct primary/secondary payer order followed?
For Medicare + commercial: did you wait the required period before submitting to secondary?

▶More about OA-22 — stats, related codes, appeal template

78%

Recovery Rate

14-30 days

Avg. Resolution

Medium

Difficulty

Common

Frequency

Payer-Specific Notes

How major payers handle CARC 22 by specialty.

UnitedHealthcare

Medicare/Medicaid crossover claims auto-route; verify MSP questionnaire on file

BCBS

Group health plan as primary to Medicare; verify BCBS employer group plan order

Common 835 Combinations

CARC 22 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-22The payer is denying payment because they have determined another insurance COCO-22+N270The payer has identified that another insurer may be primary but cannot process COCO-22+MA04This claim appears to be covered by a primary payer. The primary payer

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 22 denials.

We are resubmitting claim [CLAIM_NUMBER] with the primary payer's Explanation of Benefits attached. The primary payer [PRIMARY_PAYER] adjudicated claim [PRIMARY_TCN] on [ADJUDICATION_DATE] and paid $[PRIMARY_PAYMENT]. Please process the remaining balance per coordination of benefits rules.

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