Another plan should pay first.
OA — Other adjustment — most often coordination of benefits.
So it belongs to neither side yet. Work the coordination of benefits before you treat any of it as lost money.
Fix and resubmit. This is a correction, not an appeal. Appealing burns the deadline.
In the order we see it.
Another plan is primary for this patient on this date of service.
Get the primary EOB and rebill as secondary. Not an appeal.
The documentation, not the argument.
The primary payer's EOB, submitted with the claim as secondary.
The common mistake. Do not appeal this. It is a rebill as secondary, and appealing delays the money.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
Send your denial summary for the last ninety days. Four columns: payer, CARC code, count, billed amount. I will tell you which were winnable and what they were worth.
Send your denial summary No patient data. No BAA. No charge.
AppealHound