OA-270 Denials Explained: How to Identify, Appeal, and Prevent Them

Denial codes can be a significant obstacle for healthcare revenue cycle management (RCM) teams, directly impacting cash flow and operational efficiency. One common and often misunderstood denial is OA-270, which occurs when medical services are denied because the benefits are only available under the patient’s dental plan. Understanding this code and how to manage it is crucial for reducing revenue leakage and maintaining smooth operations.

In this article, we’ll break down what OA-270 denials mean, their causes, and how RCM teams can appeal and prevent them. By leveraging best practices and advanced tools like CombineHealth.ai’s Adam and Rachel, your organization can turn denial management into an opportunity for process improvement.

What Is a OA-270 Denial?

OA-270 is a denial code that indicates the claim was received by the medical plan, but the benefits for the services provided are not covered under the patient’s medical insurance. Instead, these services should be submitted to the patient’s dental plan for consideration.

The prefix “OA” stands for “Other Adjustment,” which typically indicates the payer has made an adjustment that does not fall under patient responsibility or contractual obligations. In this case, the financial responsibility depends on claim resolution and whether the insurance plan cross-pays the claim to the appropriate dental insurer.

Comparison: OA-270 vs Similar Denial Codes

Denial Code	Prefix Meaning	Reason/Description	Who's Financially Responsible
OA-270	Other Adjustment	Claim received by the medical plan, but benefits not available under this plan. Submit to dental plan.	Provider until the claim is reprocessed or appealed
CO-50	Contractual Obligation	Service is not covered under the patient’s policy.	Provider
PR-96	Patient Responsibility	Non-covered service; charges are billed to the patient.	Patient

OA-270 differs from CO-50 and PR-96 in that it specifically requires RCM teams to redirect claims to another payer, often necessitating additional coordination and time to resolve.

Common Causes of OA-270 Denials

1. Incorrect Insurance Selection: Submitting claims to the patient’s medical plan instead of their dental plan.
2. Lack of Coordination Between Plans: Failure to identify whether the service is covered under dental or medical benefits.
3. Incomplete Eligibility Verification: Missing or inaccurate details about the patient’s coverage during the registration process.
4. Insufficient Documentation: Failing to provide adequate information to help the payer determine coverage.
5. Service Misclassification: Coding errors that incorrectly categorize dental services as medical procedures.

Impact on Revenue Cycle Teams

OA-270 denials can have a cascading effect on both financial performance and operational efficiency for healthcare organizations.

Financial Impact:
- Revenue loss due to delayed or denied claims.
- Increased accounts receivable (AR) days, leading to cash flow challenges.
- Additional write-offs if claims are not reprocessed or appealed in time.
- Higher operational costs from increased denial management workloads.

Operational Impact:
- Staff time diverted to resolving denials, reducing productivity in other RCM areas.
- Increased need for payer-specific knowledge and cross-insurance coordination.
- Greater complexity in tracking and analyzing denial trends and outcomes.
- Collaboration challenges between billing, coding, and clinical teams.

To streamline denial management, RCM teams can rely on CombineHealth.ai’s Adam (AI Denial Manager), which identifies, categorizes, and tracks OA-270 denials in real time, enabling faster resolution and reducing revenue loss.

Steps To Appeal a OA-270 Denial

Appealing an OA-270 denial can be time-sensitive and requires a systematic approach. Follow these steps to improve your chances of success:

Step 1: Review the Denial Notice
Carefully examine the explanation of benefits (EOB) or electronic remittance advice (ERA) to confirm the denial reason and verify that the service is covered under the patient’s dental plan.

Step 2: Gather Documentation
Collect all relevant records, including the original claim, clinical documentation, and patient insurance details, to substantiate your appeal.

Step 3: Verify Eligibility
Ensure the patient has active dental coverage and that the denied service aligns with their benefits under the dental plan.

Step 4: Prepare Appeal Letter
Draft a concise, well-structured appeal letter that includes the denial reason, corrective actions taken, supporting documentation, and a request for claim reconsideration.

Step 5: Submit Within Deadline
File the appeal within the payer’s specified timeframe to avoid forfeiting your right to challenge the denial.

Step 6: Track and Follow Up
Monitor the status of your appeal regularly to ensure timely processing and escalate issues as necessary. CombineHealth.ai’s Rachel (AI Appeals Manager) simplifies this process by automating appeal tracking and follow-ups.

How To Prevent OA-270 Denials

Preventing OA-270 denials requires a proactive approach that focuses on front-end processes, accurate billing, and leveraging technology.

Front-End Prevention

• Conduct comprehensive eligibility verification during patient registration to identify the correct payer for the service.
• Train staff to understand payer policies and the distinction between medical and dental coverage.

Billing Best Practices

• Ensure proper coding and documentation of services to avoid misclassification.
• Implement payer-specific claim submission workflows to reduce errors.

Technology Solutions

• Use automated eligibility verification tools to confirm coverage details before claim submission.
• Leverage claim scrubbing technology to flag potential issues before claims are sent to payers.

CombineHealth.ai provides automated solutions like real-time eligibility verification and claim scrubbing to reduce rejection rates. If denials do occur, Rachel streamlines the appeals process, helping RCM teams resolve OA-270 denials faster and more efficiently.

FAQs

Q1: What does OA-270 mean in medical billing?
OA-270 indicates that the medical plan has denied the claim because benefits for the service are only available under the patient’s dental plan.

Q2: Can OA-270 denials be appealed?
Yes, OA-270 denials can be appealed by submitting the claim to the appropriate dental plan or providing additional evidence to substantiate the claim.

Q3: How long do I have to appeal?
The timeframe for appeal varies by payer but is typically outlined in the denial notice. Be sure to act promptly.

Q4: How can I prevent these denials?
Effective eligibility verification and proper claim submission are key. See our complete guide on denial prevention.