835 Denial Combination

OA-23

OA

Other Adjustment · Claim-Level Adjustment

Coordination of Benefits

What This Combination Means

This adjustment reflects how a primary or other payer's payment or adjustment impacts the current payer's liability. The current payer is reducing their payment based on what another payer has already paid or adjusted, following coordination of benefits rules. This is a standard informational adjustment in multi-payer scenarios, not an error or denial.

Financial Responsibility

other payer

The adjustment amount reflects payment responsibility already handled by another payer in the coordination of benefits sequence. No additional payment is expected from this payer for the adjusted amount.

N/A

Appeal Success

Immediate (informational write-off)

Avg. Resolution

Easy

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this OA-23 combination — not generic advice.

Not Appealable:This is an informational adjustment showing how prior payer actions affect liability, not a denial of coverage or payment error.
  1. 1

    Verify primary payer payment was received and posted

    Confirm the prior payer's ERA/EOB shows payment or adjustment for this service before accepting this secondary adjustment

  2. 2

    Compare total payments to allowed amount

    Add primary and secondary payments to ensure combined reimbursement equals the total allowed amount per COB rules

  3. 3

    Post adjustment as COB write-off

    Record this as a coordination of benefits adjustment in the billing system; no further collection action needed

Specialty Context

How OA-23 typically presents across different practice types.

Dental

Common when patients have dual dental coverage (e.g., through both parents' plans) and the secondary carrier adjusts based on primary payment under non-duplication of benefits rules

Medical

Routine in Medicare secondary payer scenarios, commercial COB situations, and when patients have multiple active health plans with defined primary/secondary relationships

Behavioral Health

Appears when behavioral health services are covered by multiple plans or when mental health carve-out vendors coordinate with primary medical plans

Individual Code References

View the standalone definition for each code in this combination.

CARC 23

Need to resolve this denial?

Get a complete resolution plan with appeal guidance for this exact combination in seconds.

Generate a free resolution plan & appeal letter →

Synthesized from official definitions — not from training data

Was this helpful?
← Back to Combo LookupBrowse All Codes →