OA 277 denial code

Claim adjustment reason code 277. Often reported as OA 277.

SHOP grace period: claim pending

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 277 means

The member's small business exchange plan is in a premium grace period, so the claim is held until premiums are settled.

Small Business Health Options Program (SHOP) plans have their own grace period when the employer falls behind on premiums. This code is meant for use during that grace period while the plan waits to see if coverage continues.

It is only used with group code OA. If premiums are paid, the plan reverses and reprocesses the claim. If not, expect a coverage denial later.

Group codes seen with 277

On a remittance, 277 comes after a group code. These are the ones it is most often reported with:

• OA 277 (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 employer's SHOP plan premium is unpaid and the grace period is running.
• The date of service falls within that grace period.
• The plan holds claims until it knows whether coverage continues.

What to do next

1. Keep the balance open and note the pending status on the account.
2. Recheck eligibility after the grace period to see whether coverage continued.
3. Watch for the reversal and corrected remittance before taking further action.

Related codes

• 257 (reason code) Exchange grace period: claim pending
• 27 (reason code) Service after coverage ended