CARC 19OA · Other Adjustment

The payer has determined this claim relates to a work injury or illness, making workers' compensation the responsible party instead.

Common causes
The diagnosis, place of service, or other claim details suggested a workplace injury, or the payer's records show an open workers' compensation claim for this patient.
Suggested fix
Verify whether the injury is actually work-related; if not, provide documentation to the payer to correct the determination. If it is, rebill the workers' compensation carrier.

Related Other Adjustment codes

109This payer isn't responsible for this claim; it needs to be sent to a different payer or contractor.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.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 19 mean?

The payer has determined this claim relates to a work injury or illness, making workers' compensation the responsible party instead.

How do I resolve CARC 19?

Verify whether the injury is actually work-related; if not, provide documentation to the payer to correct the determination. If it is, rebill the workers' compensation carrier.

Why does CARC 19 happen?

The diagnosis, place of service, or other claim details suggested a workplace injury, or the payer's records show an open workers' compensation claim for this patient.

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.