OA-23 denial code: impact of prior payer adjudication

Claim adjustment reason code 23 says: the impact of prior payer(s) adjudication including payments and/or adjustments. It is used only with group code OA (other adjustment).

It shows up on a secondary claim. The secondary payer is telling you how much of the amount it reduced because the primary payer already paid or adjusted it. On its own, it isn't a denial.

When a patient has two plans, the primary pays first and the secondary pays some or all of what is left, under its own rules. OA-23 is how the secondary shows the part the primary already covered. A secondary payment of zero can be correct, for example when the primary paid more than the secondary would have allowed.

• The secondary used the wrong primary payment amount, because the primary's information on the claim was incomplete or wrong.
• The patient's remaining responsibility from the primary wasn't considered, such as the deductible or coinsurance the secondary should have picked up.
• The secondary applied its own allowed amount incorrectly.

1. Compare the primary payer's remittance with the secondary's. The secondary should account for the primary's payment and the patient responsibility it left.
2. Check what the secondary should have paid under its rules and your contract.
3. If it paid less, ask for a reprocess or appeal, with the primary's remittance attached.
4. Only then bill the patient for what neither plan covers, remembering that some patients, such as Qualified Medicare Beneficiaries, can't be billed for Medicare cost-sharing.

• Send the primary payer's complete payment information with every secondary claim.
• Send secondary claims as soon as the primary pays.
• Check every secondary payment against what it should have been.

OA-23 is decided after the payers answer, so it is checked when the payments arrive.

Claira Health's AI agents follow every denial and every payment until it's resolved, and flag money that comes up short. Your team sees only what needs a decision, and approves every step. On a 20-minute call, we’ll walk through it using one of your own denials.

Related: CO-22, coordination of benefits. Book a 20-minute call and bring a secondary remittance.