OA-276: Services Denied by Prior Payer Not Covered

What Does OA-276 Mean?

OA-276 is an adjustment reflecting the coordination of benefits outcome where neither payer covers the service. This is informational and indicates the claim was processed through the COB waterfall without finding coverage from either payer.

CARC 276 fires when a secondary or subsequent payer denies a service because the prior payer already denied it. The current payer is essentially saying: the first payer said no, and we are not going to cover it either. This creates a cascading denial where neither payer reimburses the claim.

The key question is whether the current payer independently evaluated the claim or simply followed the prior payer's denial. In many cases, the secondary payer defers to the primary payer's coverage determination without conducting their own review. If the prior payer's denial was based on incorrect information, a coding error, or insufficient documentation, fixing the root cause at the prior payer level can unlock coverage at the current payer.

Resolution requires a two-pronged approach: first address the prior payer's denial, then resubmit to the current payer with the corrected adjudication. If the prior payer's denial is legitimate but the current payer should independently cover the service, appeal directly to the current payer with documentation supporting coverage under their plan.

Common Causes

How to Resolve

Address the prior payer's denial first, then resubmit or appeal to the current payer with corrected information or independent coverage justification.

1. Review the COB chain Understand how the claim flowed through coordination of benefits and why both payers denied coverage.
2. Check the prior denial Verify the prior payer's denial was correct. If not, appeal there first.
3. Request independent review If appropriate, ask the current payer to independently evaluate coverage rather than deferring to the prior payer.

How to Prevent OA-276

• Resolve primary payer denials before submitting to secondary payers
• Provide complete prior payer adjudication data to secondary payers
• Verify COB policies with all payers involved

General Prevention

• Resolve prior payer denials before submitting to secondary payers when possible
• Provide complete primary payer adjudication information to secondary payers
• Verify coordination of benefits policies with the current payer

Also Filed As

The same CARC 276 may appear with different Group Codes:

Related Denial Codes