OA 215 denial code

Claim adjustment reason code 215. Often reported as OA 215.

Subrogation from a third-party settlement

Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated Nov 11, 2026.

What 215 means

The payer adjusted the claim because another party's settlement for the injury is expected to cover these costs.

Subrogation means the payer steps into the patient's shoes to recover from whoever caused the injury. Here the payer is reducing or reversing its payment because a third-party settlement applies.

This shows up often on accident claims. The money may need to come from the liability carrier, the settlement or the patient's attorney.

Group codes seen with 215

On a remittance, 215 comes after a group code. These are the ones it is most often reported with:

• OA 215 (Other Adjustment): Used for adjustments that are neither the provider's contractual write-off nor the patient's share. It often appears with coordination of benefits, for example when another payer already paid.

The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.

Common causes

• The patient was injured in an accident caused by another party who settled the claim.
• The payer recovered or expects to recover its costs from a liability settlement.
• An accident questionnaire showed third-party liability for the injury.

What to do next

1. Ask the patient for the liability carrier or attorney contact details.
2. Bill the liability carrier or file a lien as appropriate under local rules.
3. Coordinate with the payer's subrogation unit if you are unsure who should pay.
4. Hold patient billing until the settlement path is clear.

Related codes

• 201 (reason code) Patient owes under a set-aside agreement
• 22 (reason code) Another payer may be primary
• 23 (reason code) Prior payer payment affected this claim