Did your healthcare practice recently receive an OA 23 denial code? There is no need to panic. We will discuss and teach you how to resolve the denial code 23.
That’s right, we will break down every detail about this denial code, from the reasons to the resolution tips. So, stay with us throughout the read to find out why payers deny claims with this code.
OA 23 Denial Code – Description
Denial code 23, also represented as OA 23, where OA stands for Other Adjustment, indicates that the claim has been denied or payment is reduced due to the prior payer’s adjudication, including payments and adjustments.
The denial code OA 23 occurs when there is a coordination issue between the primary and secondary payer. To put it simply, this denial typically occurs when the primary payer has already paid the amount the secondary payer was supposed to pay, resulting in zero outstanding payment. For example,
| Primary Insurance Payer | Secondary Insurance Payer |
|---|---|
| Total Billed: $500.00 Allowable Amount: $350.00 Paid: $330.00 Coinsurance: $20.00 | Total Billed: $500.00 Allowable Amount: $240.00 Paid by Primary Payer: $330.00 Balance Payment: $0.00 |
In this scenario, the secondary payer’s allowable is $340. However, $330 has already been covered by the primary insurance payer, and the patient has paid the remaining $20 as coinsurance.
But since the provider did not attach the Explanation of Benefits (EOB) received from the primary payer, or again billed the secondary payer the full $500, the OA 23 denial code will be triggered to indicate that the secondary payer cannot move forward with reimbursement without receiving details of the primary payer’s adjudication.
Note that in the case of denial code 23, the primary insurance payer’s paid amount usually exceeds the secondary payer’s allowable amount, resulting in negative balances or $0 payments.
What Causes the OA 23 Denial Code?
Here are some key reasons for the denial code OA 23.
Inaccurate Adjustment
Sometimes the primary payer may make mistakes during claims processing. They may misunderstand or misinterpret the technical information, or release incorrect payments due to insufficient or missing documentation. In such cases, the secondary payer’s adjudication is affected, and you may receive the OA 23 denial code.
Coordination of Benefits (COB) Issues
If a patient has multiple insurance policies, this may also trigger an OA 23 denial code. The benefits must be coordinated effectively between payers. Otherwise, incomplete COB information can delay claim processing and lead to confusion about the actual reimbursement.
Missing Explanation of Benefits (EOB)
You may also receive a denial code 23 if you file a claim to the secondary payer without submitting the primary payer’s EOB or mentioning the correct payment details. This may create confusion between the payers, as the secondary payer will be unaware that the claim has already been processed by the primary payer.
Duplicate Claims
Sometimes the payer receives duplicate claims from the provider, which also leads to the OA 23 denial code. It happens when there are two claims for the same service. The payer then adjusts the payment by sending a denial. In other words, it sends OA 23 to inform the provider that we have already reimbursed this claim, and $0 outstanding remains.
How to Prevent the OA 23 Denial Code?
You do not need to worry after reading the reasons. We will provide you with tips on how to prevent the denial code OA 23.
Verify Patient’s Eligibility & Benefits
Your medical billing team needs to gather all the patient information, such as the number of insurance payers, their coverage, and benefits, at the time of registration or before the appointment.
Ensure Accurate Documentation
Another essential point to remember is to maintain accurate information in the documents. The best tip to avoid a denial code 23 is to review each claim thoroughly before submission and ensure every vital piece of information complies with the payer’s requirements.
Avoid Duplicate Claims
Since we have discussed that submitting the same claim multiple times may result in a denial code 23, it is best to refrain from submitting duplicate claims. In this scenario, healthcare providers must apply automation tools to streamline their billing process, prevent human errors, and ensure efficient claim submissions.
Train Your Billing Staff
Proper staff training is crucial to avoid mistakes associated with various insurance billing. Your billing teams should be familiar with the coordination of benefits rules that specify which payer pays first and how EOB adjustment codes are interpreted. If your billers are competent and well-trained, they identify and fix the problems before filing claims to the secondary payer.
How to Resolve Denial Code OA 23?
Now that we are done talking about the causes of OA 23 denial and the prevention steps healthcare practitioners should take to avoid it, let’s look at what measures can be taken to reverse denial code 23.
- The first step is to thoroughly review the primary payer’s EOB. This will help you understand the billed amount, allowed amount, payment issued, adjustments, write-offs, and the patient’s responsibility.
- In the second step, verify whether all the required information and documents were submitted to the secondary payer for accurate COB.
- Despite that, if any underpayments or discrepancies occurred in the adjudication process, discuss the denial with the secondary insurance payer and request clarification of the payment.
- If the OA 23 remains unreversed, gather all the relevant documents, including medical records, claim copies, EOB, and other transaction details, to file an appeal.
- Submit your appeal within the resubmission timeframe, which is often set 30-90 days from the denial.
- Track and follow up on your appeal regularly for a timely resolution.
Final Word
We have broken down the OA 23 denial code in this guide. This denial code occurs when the primary insurance payer’s adjudication affects the secondary payer’s claim processing. It may occur due to a variety of factors, but the main ones are incorrect payment adjustments and coordination of benefits issues. However, you can take preventive measures, such as confirming the patient’s insurance details at the time of registration and training your staff on COB rules to avoid this denial code. Furthermore, you must follow a step-by-step approach to resolve this denial code.
If you’re still unable to manage your COB-related denials, you can get professional denial management services from NeuraBill. They have an impressive track record of reversing denials and recovering payments.
