OA-232: Institutional Transfer DRG Difference

What Does OA-232 Mean?

OA-232 appears in complex multi-facility transfer scenarios where the DRG amount difference does not fall strictly under contractual terms, such as when multiple facilities and payers are involved in the transfer chain.

CARC 232 applies exclusively to institutional claims and addresses the payment calculation when a patient is transferred between facilities during an inpatient stay. Under DRG-based payment systems, when a patient is transferred from one institution to another, the transferring hospital typically receives a per-diem payment rather than the full DRG amount, while the final discharging hospital receives the standard DRG payment. Code 232 explains this payment difference.

The transferring hospital's payment is calculated based on the number of days the patient was in their facility, up to the full DRG amount. This means the transferring facility often receives less than the full DRG rate, and CARC 232 communicates the amount of that reduction. The adjustment is a function of CMS transfer payment policy, not necessarily an error on the claim.

This code most commonly appears with Group Code CO (contractual obligation), meaning the payment difference is a contractual adjustment the provider must accept. It can also appear with OA in complex multi-facility transfer scenarios.

How to Resolve

Verify transfer documentation accuracy, confirm the DRG per-diem calculation is correct, and appeal only if the payment amount is lower than expected under the transfer policy.

1. Map the transfer chain Identify all facilities involved in the patient's transfer chain and verify that each facility's claim accurately reflects its portion of the stay.
2. Coordinate with other facilities Contact the other institutions involved to reconcile transfer dates, documentation, and DRG assignments across the full episode of care.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-232:

How to Prevent OA-232

• Establish inter-facility communication protocols for transfer documentation
• Implement standardized transfer documentation practices across affiliated institutions

Also Filed As

The same CARC 232 may appear with different Group Codes:

Related Denial Codes