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OA-P11 Denial Code: P&C Claim Pending Due to Litigation

OA-P11 means the disposition of the related property and casualty claim (the injury or illness) is pending because of litigation. The payer can't decide on this bill until the underlying claim is resolved in the legal process.

Quick facts

Code
OA-P11 (CARC P11)
Status
Active In use since November 1, 2013.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • OA (Other Adjustment): The only group allowed for P11. Responsibility isn't assigned to the provider or the claimant while the claim is pending.
Official description
The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. To be used for Property and Casualty only. (Use only with Group Code OA)
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What OA-P11 means

CARC P11 says the disposition of the related property and casualty claim (injury or illness) is pending due to litigation. X12 limits it to property and casualty claims and requires group code OA. It replaced deactivated CARC 255.

Every medical bill on a P&C case depends on the underlying claim: the workers’ comp claim, auto claim, or liability claim for the injury. When that underlying claim is in litigation, the carrier can’t say whether it’s responsible, so it reports the bill as pending with OA-P11.

Compared with CO-P10, OA-P11 emphasizes that the underlying claim’s outcome is undecided. It doesn’t assign any amount to you or the claimant. Both codes call for the same practical response: keep the account open and track the case.

Common causes

  • Workers’ comp compensability contested before a state board or court.
  • Auto coverage disputes, such as policy eligibility or fault questions affecting coverage.
  • Liability suits where the defendant’s insurer is waiting on the outcome.
  • Disputes about whether the injury caused the conditions being treated.

How to handle it

  1. Note the litigation status on the account, with claim numbers and contacts.
  2. Ask the carrier and the claimant’s attorney about the case and expected timeline.
  3. Protect your interest. Where state law permits, notify the attorney of the outstanding bill or file a lien.
  4. Consider other coverage, such as the health plan, if its rules and state law allow.
  5. Follow up regularly, and request a final decision once the case ends.

How to prevent problems

  • Ask injury patients about attorneys and pending legal action at intake.
  • Set up a litigation queue so pending accounts are tracked separately and not written off.
  • Watch filing limits for any other payer you may need to bill later.

Specialty notes

Practices with personal injury caseloads, such as chiropractic, spine, and orthopedics, should have a process for tracking litigated accounts over long periods, since cases can take a long time to resolve.

Remark codes that may appear with OA-P11

  • N611 (Claim in litigation.): The claim is in litigation; contact the insurer for details.
  • N581 (Investigation of coverage eligibility is pending.): Investigation of coverage eligibility is pending.
  • OA-255Deactivated (The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. (Use only with Group Code OA)): The deactivated code that CARC P11 replaced.
  • CO-P10 (Payment reduced to zero due to litigation.): Payment on this bill reduced to zero due to litigation.
  • CO-P8 (Claim is under investigation.): The claim is under investigation rather than in litigation.
  • OA-133 (The disposition of this service line is pending further review. (Use only with Group Code OA).): The disposition of a service is pending further review, used outside P&C.

OA-P11 FAQ

Why is OA-P11 reported under the OA group?

X12 requires OA for this code because no one has been assigned responsibility yet. The amount isn't a contractual write-off and isn't patient responsibility.

What should I do with an OA-P11?

Keep the bill open, record the litigation, and follow up with the carrier or the claimant's attorney. The bill will need action once the case is decided.

Could a health plan pay in the meantime?

Depending on the plan and state law, a health plan may pay and seek reimbursement later, or wait for the P&C outcome. Check the plan's rules.

Does OA-P11 apply to health insurance?

No. It's for property and casualty claims only.

Should I write off an OA-P11 balance?

No. The outcome is undecided, so the balance should stay open until the litigation ends and the carrier issues a final decision.