OA-193: Original Payment Decision Maintained

What Does OA-193 Mean?

OA-193 signals that an original payment decision was maintained in a coordination of benefits or other adjustment context. The payer determined that the adjustment between payers was correctly applied and no change is warranted. This may appear when a secondary payer reviews the primary payer's adjudication and upholds the balance allocation.

When CARC 193 shows up on a remittance, the payer is telling you that a reconsideration, redetermination, or appeal has been completed and the original payment decision stands. This is not a new denial — it is the payer's confirmation that the previous adjustment or denial was reviewed and found to be correct. You will typically see this code after submitting an appeal, requesting a reconsideration, or disputing a prior claim adjudication.

The significance of CARC 193 depends heavily on the group code. Under CO, the payer is maintaining a contractual adjustment — perhaps a fee schedule reduction, a bundling edit, or a coverage exclusion — and the provider must absorb the write-off unless a higher-level appeal is pursued. Under PR, the payer is reaffirming that the patient owes a specific amount (deductible, coinsurance, or non-covered charge) after the provider or patient challenged that determination. In both cases, the original rationale for the adjustment remains unchanged.

Receiving CARC 193 does not necessarily mean the case is closed. Most payer appeal processes have multiple levels, and you may still have the option to escalate. For Medicare, the progression runs from redetermination to reconsideration by a QIC, then to an ALJ hearing and beyond. For commercial payers, check the contract for the number of appeal levels available. The key question is whether you have new clinical documentation, corrected coding, or a different legal argument that was not presented in the initial challenge.

How to Resolve

Determine whether the upheld decision is correct, and if not, escalate to the next available appeal level with new supporting evidence.

1. Review COB determination Examine the coordination of benefits adjudication to confirm the payer priority order and adjustment allocations are correct.
2. Submit to the next payer if applicable If there is another payer in the sequence that has not yet adjudicated, forward the claim with the current remittance data.
3. Transfer remaining balance appropriately After all payers have adjudicated, post any remaining balance to the patient's account or write it off per the applicable contractual terms.

How to Prevent OA-193

• Maintain accurate and up-to-date coordination of benefits information for all patients with multiple insurance plans
• Submit claims in the correct payer priority order to avoid unnecessary OA adjustments and subsequent appeals

Also Filed As

The same CARC 193 may appear with different Group Codes:

Related Denial Codes