A prior payer already adjusted this, and that adjustment carries over.
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.
The primary payer's allowed amount and adjustments flowed through to the secondary payer.
The primary EOB was not attached, so the secondary could not reconcile the balance.
Read the primary EOB first. This is usually the secondary correctly honouring the primary's allowed amount, not a denial.
The documentation, not the argument.
The primary payer's EOB, attached to the secondary claim.
The common mistake. Do not appeal this as a denial. In most cases the secondary is behaving correctly and the balance is contractual or patient responsibility.
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