OA-23: Impact of Prior Payer Adjudication (COB)
OA (Other Adjustment)What is OA-23?
OA-23 is an Other Adjustment code indicating the payment was adjusted based on the primary payer's adjudication under coordination of benefits (COB). This is an informational adjustment, not a denial. The secondary payer processed the claim and applied the primary payer's payment and adjustments before calculating their own payment.
Why Does OA-23 Occur?
- Standard COB processing. The secondary payer reduced their payment based on what the primary payer already paid. This is normal COB behavior.
- Primary payer paid more than expected. The secondary payer's adjustment reflects that the primary covered most or all of the allowed amount.
- Primary payer denied the claim. The secondary payer may adjust based on the primary's denial, depending on the secondary plan's COB terms.
How to Fix OA-23 Denials
- Review the EOB from both the primary and secondary payers. Confirm the secondary correctly applied the primary's payment and adjustments.
- If the combined payment from both payers equals the total allowed amount, no action is needed. OA-23 is working as intended.
- If the calculation is incorrect, contact the secondary payer with both EOBs showing the discrepancy.
- If the primary payer denied the claim incorrectly, resolve the primary denial first, then resubmit to the secondary.
OA-23 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | N/A | N/A | COB adjustment. No appeal needed unless calculation is incorrect. |
| Anthem | N/A | N/A | COB adjustment. No appeal needed unless calculation is incorrect. |
| Aetna | N/A | N/A | COB adjustment. No appeal needed unless calculation is incorrect. |
| Cigna | N/A | N/A | COB adjustment. No appeal needed unless calculation is incorrect. |
| Medicare | N/A | N/A | COB adjustment informational. No appeal needed. |
Related CARC Codes
If you are seeing OA-23, check these related codes: CO-22 (coordination of benefits required), CO-44 (subscriber not eligible), PR-1 (deductible).
Common Questions About OA-23
Is OA-23 a denial?
No. OA-23 is an informational adjustment showing how the secondary payer calculated their payment based on the primary's adjudication. It is standard coordination of benefits processing.
Do I need to appeal OA-23?
Usually not. OA-23 is working as designed. Only take action if the secondary payer's calculation is incorrect based on the primary's EOB.
Altair catches OA-23 denials before submission with automated COB tracking. See how pre-submit claim scoring works.