DENIAL CODE · OA-22

OA-22: Coordination of Benefits

OA-22 means the payer believes another plan is primary, or the patient's COB information is out of date, so it won't pay until the order is resolved.

Official (X12/WPC): "This care may be covered by another payer per coordination of benefits."
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Why payers issue OA-22

  • The patient has a second plan and the primary/secondary order is unclear
  • The member's COB record on file is outdated
  • The primary payer's EOB wasn't attached to the secondary claim
  • Eligibility or coverage dates overlap

Is it recoverable? Usually a sequencing problem, not a coverage problem — once the order and primary EOB are in place, the claim pays.

How to appeal a Coordination of Benefits denial →

Common questions

What does OA-22 mean?

OA-22 means the payer believes another plan is primary, or the patient's COB information is out of date, so it won't pay until the order is resolved. This care may be covered by another payer per coordination of benefits.

How do I appeal or fix an OA-22 denial?

Usually a sequencing problem, not a coverage problem — once the order and primary EOB are in place, the claim pays. Common causes: the patient has a second plan and the primary/secondary order is unclear; the member's COB record on file is outdated; the primary payer's EOB wasn't attached to the secondary claim; eligibility or coverage dates overlap.

Is an OA-22 denial worth appealing?

Usually a sequencing problem, not a coverage problem — once the order and primary EOB are in place, the claim pays. You only pay on what's actually recovered, so there's no cost to working the ones that are winnable.

Other denial codes
CO-197 · Precertification / Authorization Absent →CO-50 · Not Medically Necessary →CO-16 · Missing or Invalid Information →CO-45 · Charge Exceeds Fee Schedule →CO-97 · Bundled into Another Service →CO-29 · Timely Filing Expired →CO-96 · Non-Covered Charge →OA-18 · Duplicate Claim →CO-11 · Diagnosis Inconsistent with Procedure →CO-151 · Too Many Services (Frequency/MUE) →CO-B7 · Provider Not Eligible →CO-27 · Coverage Terminated →CO-204 · Not Covered Under Current Plan →CO-109 · Not Covered by This Payer →CO-119 · Benefit Maximum Reached →CO-4 · Modifier Inconsistent or Missing →CO-15 · Authorization Number Missing or Invalid →OA-23 · Prior Payer Adjudication Impact →CO-24 · Charges Covered Under Capitation →CO-26 · Expenses Incurred Prior to Coverage →CO-54 · Assistant Surgeon Not Covered →CO-55 · Experimental / Investigational →CO-58 · Inappropriate Place of Service →CO-59 · Multiple/Concurrent Procedure Reduction →CO-107 · Related/Qualifying Claim Not Identified →CO-167 · Diagnosis Not Covered →CO-170 · Denied for This Provider Type →CO-181 · Procedure Code Invalid on Date of Service →CO-182 · Procedure Modifier Invalid on Date of Service →CO-183 · Referring Provider Not Eligible to Refer →CO-185 · Rendering Provider Not Eligible →CO-198 · Precertification / Authorization Exceeded →CO-226 · Requested Provider Information Not Provided →CO-231 · Mutually Exclusive Procedures →CO-234 · Procedure Not Paid Separately →CO-236 · Procedure/Modifier Combination Not Compatible →CO-242 · Out-of-Network / Non-Network Provider →CO-252 · Documentation Required to Adjudicate →CO-253 · Sequestration Reduction →CO-256 · Not Payable Per Managed-Care Contract →CO-288 · Referral Absent →CO-B15 · Qualifying Service Not Received →CO-B16 · New Patient Qualifications Not Met →CO-A1 · Claim/Service Denied (Remark Required) →

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