OA-187: Consumer Spending Account Payment Not Approved

What Does OA-187 Mean?

OA-187 is less common and may appear when the spending account rejection involves a coordination issue between the payer and the spending account administrator, or when the rejection reason does not clearly assign responsibility to the patient.

CARC 187 appears on your remittance when a Consumer Spending Account payment attempt is declined by the account administrator. This code is unique because it involves a third-party payment source that is separate from the patient's traditional insurance — the FSA, HSA, or HRA is funded by the patient or their employer, and each account has its own eligibility rules for what qualifies as a covered medical expense.

The most common triggers are administrative in nature. Incorrect account numbers, wrong patient identification, or outdated account information will cause the spending account administrator to reject the payment. Missing documentation is the second most frequent cause — many FSA and HRA administrators require itemized receipts or Explanation of Benefits documents before they will approve a disbursement. The service itself may also be ineligible under the patient's specific plan, as FSA, HSA, and HRA eligible expense lists can differ.

The financial dynamics of CARC 187 are different from typical insurance denials. The spending account payment was meant to cover the patient's out-of-pocket share (copay, deductible, coinsurance), not the insurance-covered portion. When the spending account payment fails, the patient still owes the money — they just need to pay through a different method. The provider's role is to help the patient understand why the spending account payment was rejected and collect the balance through standard patient payment channels.

How to Resolve

Verify the spending account status and eligibility, correct any errors, and either resubmit to the account administrator or collect from the patient through alternative payment methods.

1. Contact the spending account administrator Reach out to the FSA/HSA/HRA administrator to understand why the payment was flagged under OA rather than PR and what additional information is needed.
2. Resolve coordination issues If the rejection involves a coordination issue between the insurance payer and the spending account, work with both parties to ensure proper sequencing of payments.

How to Prevent OA-187

• Understand each spending account administrator's submission requirements and coordinate with the insurance payer for proper claim sequencing
• Document all interactions with spending account administrators for future reference

Also Filed As

The same CARC 187 may appear with different Group Codes:

Related Denial Codes