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OA-277 Code: Pending During SHOP Premium Grace Period

OA-277 means the claim's outcome is undetermined because the employer's coverage is in a premium payment grace period under Health Insurance SHOP Exchange rules. The payer will reverse and correct the claim when the grace period ends, depending on whether premiums are paid.

Quick facts

Code
OA-277 (CARC 277)
Status
Active In use since November 1, 2015.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • OA (Other Adjustment): The only group X12 allows for CARC 277. Nothing is paid or assigned yet; the claim is waiting on the grace period outcome.
Official description
The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What OA-277 means

CARC 277 says the disposition of the claim or service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements, and that the claim will be reversed and corrected when the grace period ends. It’s used only with group OA, and X12 notes it’s meant for the 31-day SHOP grace period.

SHOP is the Small Business Health Options Program, where small employers buy group coverage through the Marketplace. When an employer falls behind on premium payments, coverage may continue for a grace period while the plan waits to see whether the premium is paid. Claims during that window can be pended rather than paid or denied. OA-277 is how the plan tells you that’s happening.

The code is a close relative of OA-257. The difference is who holds the policy: OA-257 applies to individual Marketplace enrollees, often those receiving premium tax credits, while OA-277 applies to employer coverage purchased through SHOP. For you, the practical effect is similar: the claim is on hold, not denied.

Common causes

  • Employer missed a premium payment for SHOP coverage.
  • Employer is changing or dropping coverage, and the last premium is unpaid.
  • Administrative delay in premium processing between the employer and the plan.

How to handle it

  1. Post OA-277 as a pending status, not as a write-off or patient balance.
  2. Tell the patient their employer’s premium may be past due, so they can check with their employer.
  3. Watch for the corrected remittance after the grace period. It will either pay the claim or reverse it.
  4. If the claim is reversed for non-payment, verify eligibility, ask the patient about other coverage, and bill any new payer or the patient according to your policy.
  5. Avoid resubmitting during the grace period, which can create duplicates.

How to prevent problems

  • Verify eligibility before each visit. Some payers report grace period status in eligibility responses.
  • Ask small-business employees at check-in whether their coverage has changed.
  • Track pended claims so they’re followed up when the grace period ends. An ERA Analyzer can list OA-277 claims awaiting resolution.
  • Discuss payment options with patients whose coverage status is uncertain. See eligibility and COB denials.

Remark codes that may appear with OA-277

  • N698 (Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment…): Appears on a later reversal when premiums weren't paid by the end of the grace period.
  • OA-257 (The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements.): The same pending status for individual Marketplace enrollees in a premium grace period, rather than SHOP employer coverage.
  • PR-27 (Expenses incurred after coverage terminated.): Expenses after coverage terminated, which may follow if premiums aren't paid.
  • CO-200 (Expenses incurred during lapse in coverage): Expenses incurred during a lapse in coverage.
  • OA-133 (The disposition of this service line is pending further review. (Use only with Group Code OA).): Disposition pending further review, a general pending code.

OA-277 FAQ

What is the SHOP Exchange?

The Small Business Health Options Program, the part of the Health Insurance Marketplace where small employers offer coverage to employees. SHOP coverage is paid by the employer, so the premium grace period relates to the employer's payment.

How long is the SHOP grace period?

X12's note on this code says it is used during a 31-day SHOP grace period. The plan's own documents and applicable rules control the details.

What happens to the claim afterward?

The payer reverses and corrects the claim when the grace period ends. If premiums are paid, the claim is processed normally. If not, coverage can terminate and the claim is denied, often shown with a reversal remark such as N698.

Should I bill the patient while the claim is pending?

Usually wait. Contact the patient so they can check with their employer, and hold the balance until the payer issues its corrected remittance.