CARC 136OA · Other Adjustment
The claim wasn't processed correctly because it didn't follow the rules or requirements set by a prior (primary) payer.
- Common causes
- Coordination-of-benefits claims that skip a required step, such as not obtaining the primary payer's authorization before this payer's involvement.
- Suggested fix
- Review the primary payer's requirements, complete any missing steps, and resubmit with proof of compliance.
Related Other Adjustment codes
109This payer isn't responsible for this claim; it needs to be sent to a different payer or contractor.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 136 mean?
The claim wasn't processed correctly because it didn't follow the rules or requirements set by a prior (primary) payer.
How do I resolve CARC 136?
Review the primary payer's requirements, complete any missing steps, and resubmit with proof of compliance.
Why does CARC 136 happen?
Coordination-of-benefits claims that skip a required step, such as not obtaining the primary payer's authorization before this payer's involvement.
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.