CARC 109OA · Other Adjustment
This payer isn't responsible for this claim; it needs to be sent to a different payer or contractor.
- Common causes
- The patient's coverage has moved to a different plan or contractor, or the claim was sent to the wrong regional payer or Medicare contractor.
- Suggested fix
- Confirm the patient's current payer or contractor and resubmit the claim to the correct one.
Related Other Adjustment codes
136The claim wasn't processed correctly because it didn't follow the rules or requirements set by a prior (primary) payer.140The member ID number submitted doesn't match the patient or subscriber name on file with the payer.18This claim or service line is an exact duplicate of one already submitted and processed.19The payer has determined this claim relates to a work injury or illness, making workers' compensation the responsible party instead.215Payment was adjusted based on a third-party settlement where the payer has subrogation rights to recover costs.22The payer believes another insurance plan should be billed first or is otherwise responsible under coordination-of-benefits rules.23This adjustment reflects how a prior payer already processed the claim, reducing what this payer pays as a result.253Payment was reduced due to mandatory federal budget sequestration, a government-wide across-the-board cut applied to Medicare payments.
Frequently asked questions
What does CARC 109 mean?
This payer isn't responsible for this claim; it needs to be sent to a different payer or contractor.
How do I resolve CARC 109?
Confirm the patient's current payer or contractor and resubmit the claim to the correct one.
Why does CARC 109 happen?
The patient's coverage has moved to a different plan or contractor, or the claim was sent to the wrong regional payer or Medicare contractor.
CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.