23Denial Code (CARC)Active
OA 23 Denial Code - Prior Payer Adjustment Impact
Code 23 indicates that the claim has been adjusted due to the adjudication results from a prior payer. This means the current payer is factoring in the prior payer's payment or adjustment decisions when processing the claim.
Who Pays: Group Code Liability
With group code OA, the adjustment is an informational change reflecting another payer's decision. The provider typically cannot bill the patient for this amount, as it is not patient responsibility.
Why Claims Get Code 23
- The patient has dual insurance coverage, and the primary insurance has already paid or adjusted the claim.
- The claim was submitted to the secondary payer before the primary payer's response was processed.
- Coordination of Benefits (COB) information was incorrect or outdated, leading to processing errors.
- The primary insurance's payment exceeded the allowed amount under the secondary payer's policy.
- Secondary payer received the claim without the primary payer's Explanation of Benefits (EOB) attached.
How to Fix & Resubmit
- Verify that the primary payer's adjudication details are correct and properly documented.
- Ensure that the Coordination of Benefits (COB) information is up-to-date and accurate.
- Check that the primary payer's Explanation of Benefits (EOB) is attached to the claim submitted to the secondary payer.
- If the primary payment is incorrect, contact the primary payer for clarification or adjustment.
- Submit a corrected claim to the secondary payer with the correct EOB if necessary.
Corrected Claim or Appeal?
A corrected claim is appropriate if the primary payer's EOB was missing or incorrect information was submitted. An appeal is usually not necessary unless there is a dispute with the primary payer's adjudication.
Preventing Future 23 Denials
- Always verify and update COB information at each patient visit to ensure accuracy.
- Ensure that primary payer's EOBs are consistently attached to claims sent to secondary payers.
- Train billing staff on the importance of accurate insurance sequencing and documentation.
- Implement a checklist for verifying dual coverage claims before submission to secondary payers.