CommonOther Adjustment (OA)Coordination of Benefits

OA-23: Impact of prior payer adjudication

The payment or adjustment is based on how the prior (primary) payer adjudicated the claim. This is common when billing secondary insurance -- the secondary payer's payment is influenced by what the primary payer paid or denied.

Common Causes

  • Secondary payer adjusting based on primary payer's EOB
  • Primary payer denial impacting secondary payer adjudication
  • Coordination of benefits adjustment
  • Medicare as secondary payer calculations

How to Resolve OA-23

  1. 1Review the primary payer's EOB to understand the basis for the secondary adjustment
  2. 2If the primary payer EOB was not submitted with the secondary claim, resubmit with it
  3. 3If the primary payer adjudication was incorrect, correct it with the primary first, then resubmit to secondary
  4. 4Verify the COB order is correct

How to Prevent OA-23 Denials

  • Always submit the primary payer EOB when billing secondary insurance
  • Ensure COB order is correctly determined at registration
  • Process primary claims promptly to avoid secondary filing deadline issues

Related Denial Codes

CO-109Common

Claim not covered by this payer

CO-22Moderate

Care may be covered under a capitation or managed care plan

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