OA P11 denial code
Claim adjustment reason code P11. Often reported as OA P11.
On hold for a related lawsuit
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 .
What P11 means
Payment is on hold because a related property and casualty claim is in litigation, and its outcome affects this one.
You will see it only on property and casualty remittances, for example from a workers' compensation or auto carrier. P11 says this claim's outcome depends on a related claim that is being litigated, so the payer is not deciding it yet.
The code is only used with group code OA. That fits its nature: it is a holding status, not a provider or patient liability decision.
Group codes seen with P11
On a remittance, P11 comes after a group code. These are the ones it is most often reported with:
- OA P11 (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
- A related auto or liability claim is in court.
- Who is at fault is not yet decided.
- Another carrier's responsibility is being contested.
What to do next
- Find out which related claim is in litigation and who is handling it.
- Track the case and keep the account open until it is resolved.
- Check for other coverage that may pay in the meantime, following the payer's rules.
Related codes
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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