277Denial Code (CARC)Active
OA 277 Denial Code - Resolve SHOP Grace Period Holds
CARC 277 indicates that the claim's status is on hold because the patient is in the premium payment grace period under the Health Insurance SHOP Exchange. During this time, the claim will not be processed until the grace period concludes, at which point it will be either reversed or corrected depending on whether the premium is paid.
Who Pays: Group Code Liability
With group code OA, the provider cannot bill the patient for the amount in question. This adjustment is a temporary hold, not a final decision on liability.
Why Claims Get Code 277
- The patient is within the 31-day SHOP grace period for premium payment.
- The payer is waiting to see if the patient's premium gets paid before finalizing the claim.
- The claim was submitted during the grace period, triggering the hold.
- The payer requires confirmation of premium payment status before processing.
- The claim is part of a health insurance exchange plan with specific grace period rules.
How to Fix & Resubmit
- Verify the patient's premium payment status with the payer.
- Contact the patient to ensure their premium is paid within the grace period.
- Monitor the claim status after the grace period ends for any updates.
- If the premium is paid, expect the claim to be processed or corrected by the payer.
- If unpaid, the claim will likely be reversed; follow up with the payer for next steps.
Corrected Claim or Appeal?
A formal appeal is not applicable for CARC 277 as it is a temporary hold. Once the premium status is resolved, the claim will automatically be processed or reversed. No corrected claim is needed unless instructed by the payer after resolution.
Preventing Future 277 Denials
- Verify the patient's premium payment status before claim submission if possible.
- Set reminders to check premium statuses for patients on exchange plans.
- Educate patients on the importance of timely premium payments to avoid claim holds.
- Coordinate with payers to get timely updates on grace period outcomes.