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OA-23
Recoverability: Low
The impact of prior payer(s) adjudication, including payments and/or adjustments
This code reports how much of the billed amount was already accounted for by a prior payer's payment and adjustments. It appears with group code OA on secondary claims and is informational accounting rather than a true denial.
Why this happens on dental claims
- Secondary dental claims for dual-covered patients, where the primary plan's payment and write-off carry into the secondary plan's math
- Non-duplication of benefits clauses that reduce the secondary payment to zero when the primary paid at or above the secondary's allowance
- Posting errors where the OA-23 amount is misread as a denial or an extra write-off, inflating patient balances
How to appeal OA-23
- Reconcile the OA-23 amount against the primary explanation of benefits: it should equal the primary's payment plus its contractual adjustments
- Verify the secondary applied the correct coordination method for the plan, whether standard, non-duplication, or maintenance of benefits
- If the secondary used incorrect primary payment figures, resubmit with the correct primary explanation of benefits attached
- Post the amounts to the correct buckets so patient balances stay accurate
How to prevent it
- Attach the full primary explanation of benefits to every secondary claim at first submission
- Train posting staff to treat OA-23 as prior-payer accounting, not as a new adjustment
Related codes
How much OA-23 money is sitting in your remittances?
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