OA-143: Portion of Payment Deferred
Payment is partially deferred pending additional review or information. Check the RARC for details, provide what the payer needs, and track the deferred amount.
What Does OA-143 Mean?
OA-143 is the primary pairing for this code. The OA group code indicates the deferral is an administrative processing matter — the payer is holding part of the payment pending further information or review, and this hold does not represent a contractual write-off or patient responsibility. The deferred amount is expected to be paid once conditions are met. The provider should track it and follow up.
CARC 143 is not a denial in the traditional sense. When a payer issues CARC 143, they are telling you that they have processed the claim but are withholding a portion of the payment. The claim is not rejected — part of it may already be paid — but the remaining amount is on hold until certain conditions are met. The specific reason for the deferral varies and is communicated through the accompanying RARC code.
The most common reasons for payment deferral include pending documentation requests (the payer needs medical records or operative notes before releasing the full payment), unresolved coordination of benefits (the primary payer has not yet adjudicated the claim), and managed care withhold arrangements (the contract specifies that a percentage of payment is held back and distributed later based on performance metrics). Medical review or audit is another common trigger — the payer is reviewing a portion of the claim for medical necessity or utilization and deferring payment on that portion while paying the rest.
The key distinction with CARC 143 is that the deferred amount has not been denied. The payer intends to pay it once the conditions are met. This makes tracking and follow-up critical — deferred amounts can fall through the cracks if they are not monitored. Set a follow-up date based on the payer's typical processing timeline, and if the deferred amount is not released within that window, contact the payer proactively.
Common Causes
| Cause | Frequency |
|---|---|
| Pending additional documentation or medical records The payer is withholding a portion of the payment until the provider submits additional documentation, such as medical records, operative notes, or other clinical information needed to complete adjudication | Most Common |
| Coordination of benefits not yet resolved The payer is deferring part of the payment because the primary insurance has not yet processed the claim, or COB information is incomplete and the payer cannot determine the correct payment amount | Most Common |
| Claim under medical review or audit The payer has flagged the claim for medical necessity review, utilization review, or audit, and is deferring payment on the portion under review while processing the remainder | Common |
| Withhold arrangement under managed care contract The provider's managed care contract includes a withhold provision where a percentage of payment is deferred and paid later based on quality metrics, utilization targets, or other performance criteria | Common |
| Missing or pending prior authorization determination The payer is waiting for a prior authorization decision on part of the claim and is deferring payment on the unauthorized portion while paying the authorized portion | Common |
| Multi-payer processing delay In complex multi-payer scenarios, the payer defers a portion while awaiting determination from another entity involved in the claim adjudication process | Occasional |
How to Resolve
Identify why the payment was deferred, provide any requested documentation or information, and track the deferred amount until it is released.
- Read the RARC carefully The RARC is essential for understanding the specific reason for the deferral and what action is needed to release the payment.
- Submit requested documentation If the payer needs medical records, authorization documentation, or a primary payer EOB, submit it as soon as possible.
- Monitor and follow up Track the deferred amount and contact the payer if it is not released within the expected timeframe.
This adjustment is typically correct as processed. Review the specific circumstances before taking further action.
Common RARC Pairings
The RARC code tells you exactly what triggered the OA-143:
| RARC | Description |
|---|---|
| N130 | Alert: Review plan documents or guidelines for details on the deferred payment |
| N525 | Alert: Additional information is required for adjudication of the remaining balance |
How to Prevent OA-143
- Submit complete documentation with the initial claim to reduce the likelihood of payment deferral for missing information
- Verify coordination of benefits and primary payer processing status before submitting claims to secondary payers
- Obtain prior authorization before rendering services to prevent deferrals for pending authorization decisions
- Implement a tracking system for deferred payments so withheld amounts are not lost or forgotten
General Prevention
- Submit complete documentation with the initial claim to minimize the chance of payment deferral for missing information
- Verify COB and primary insurance processing status before submitting claims to secondary payers
- Obtain and submit prior authorization before rendering services to prevent deferrals for pending authorization decisions
- Understand the terms of managed care withhold arrangements so deferred amounts can be tracked and followed up on schedule
- Implement a tracking system for deferred payments to ensure no withheld amounts are lost or forgotten
- Submit claims promptly and respond quickly to payer requests for additional information to minimize deferral periods
Also Filed As
The same CARC 143 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/143
- https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/ClaimDenialCodes.pdf
- Codes maintained by X12. Visit x12.org for official definitions.