OA-100Other AdjustmentCoordination of Benefits
OA-100 Denial Code: Payment made to patient/insured
The payer sent the money to the patient instead of the practice — typical for out-of-network claims where benefits aren't assignable.
Why OA-100 happens
- ●Out-of-network claim where the plan pays the member directly
- ●Assignment of benefits not on file or not honored
How to fix a OA-100 denial
- 1
Bill the patient promptly with a copy of the EOB showing they received the funds
- 2
For future claims, collect at time of service for plans known to pay members
How to prevent it
Identify member-pay plans during eligibility and set expectations (or deposits) up front.
Drowning in OA-100 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.