OA-P10: Payment Reduced to Zero Pending Litigation

What Does OA-P10 Mean?

OA-P10 is the standard pairing and indicates the payment hold is an interim adjustment — not a final denial. The carrier has not made a coverage or liability determination because litigation prevents it. The provider should not write off the balance or bill the patient while the case is pending. Once the litigation concludes, the carrier will reprocess the claim and issue a final determination.

CARC P10 is applied when the P&C carrier has reduced the claim payment to zero because of ongoing litigation that prevents the carrier from making a payment determination. This code replaces the older CARC 244 and is exclusive to Property and Casualty claims. The carrier has indicated that additional information will be sent following the conclusion of the litigation.

The litigation behind P10 can take many forms. It may be a dispute between the insured and the carrier over policy coverage, a fault or liability determination in a personal injury case, a subrogation action against a third party, or a fraud investigation that has escalated to legal proceedings. Regardless of the specific legal issue, the effect on the provider is the same — payment is suspended entirely until the litigation resolves.

P10 creates a significant cash flow challenge because the payment hold is typically open-ended. The provider has no guarantee of when the litigation will conclude, and some cases extend for months or years. Providers should set up dedicated tracking for P10 claims, consider filing medical liens where jurisdictionally permitted to protect their claim to payment from any eventual settlement or judgment, and consult legal counsel if the hold becomes unreasonably prolonged.

Common Causes

How to Resolve

Track the litigation status, file protective medical liens if applicable, and request claim reprocessing once the litigation concludes.

1. Confirm the litigation hold Contact the carrier to confirm the P10 hold and get details about the expected resolution timeline.
2. File a medical lien Protect your claim to payment by filing a medical lien against the case if your jurisdiction allows it.
3. Monitor and follow up Schedule regular check-ins with the carrier to track the litigation status. Keep the claim active in your A/R system.
4. Process the final ERA When the litigation concludes and a final ERA is issued, process it according to the group code and adjustment reason on the updated remittance.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-P10:

How to Prevent OA-P10

• Inquire about the litigation status of P&C cases at patient intake to identify potential payment holds before rendering services
• Establish communication channels with P&C carriers to receive early notice of litigation that may affect claim payment
• Build P10 tracking into your A/R aging reports so litigation-held claims do not fall through the cracks
• Consult with legal counsel proactively about filing medical liens for large-balance P&C cases

General Prevention

• Maintain thorough and accurate documentation of all services to minimize disputes that could lead to litigation
• Verify P&C coverage and liability status before providing services to identify claims that may be subject to ongoing litigation
• Establish communication with the P&C carrier early in the treatment process to stay informed of any liability disputes or legal proceedings
• Submit claims promptly with complete documentation to avoid delays that could complicate cases already in litigation
• Build relationships with P&C carrier claims adjusters to receive early notice of potential litigation holds on claims

Also Filed As

The same CARC P10 may appear with different Group Codes:

Related Denial Codes