How do I fix or resolve code 23?

Verify the coordination of benefits order and confirm that the primary payer has already adjudicated the claim; obtain the primary payer's EOB/ERA for reference. Cross-check the primary payer's payment and adjustment amounts against the secondary payer's adjustment to ensure the combined total does not exceed the allowed amount and no duplicate payments are being made. If the secondary payer's adjustment appears incorrect — for example, it does not account for the primary's payment or applies the wrong COB calculation — file a claim reconsideration with the primary EOB attached. Post the adjustment in the practice management system, ensuring the patient balance reflects only the remaining coinsurance, deductible, or copay after both payers have adjudicated. If the adjustment results in a zero balance and the claim is fully satisfied, close the account; if a patient balance remains, bill the patient with a statement showing both payers' adjudications.

23Adjustment CodeGeneral Adjustment

Code 23

Problem Description

The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)

Root Cause

The adjustment reflects the impact of prior payer adjudication, including payments and/or adjustments already made by another payer. This is used with Group Code OA (Other Adjustment) when coordination of benefits applies — a primary payer has already adjudicated the claim, and the secondary payer is adjusting its payment to account for what the primary has already paid or adjusted. The adjustment is not a denial but a coordination calculation. Common scenarios include Medicare as secondary payer, dual commercial coverage, or workers' compensation coordination. The payer ensures combined payments from all payers do not exceed the total allowed amount.

Resolution Steps

1Verify the coordination of benefits order and confirm that the primary payer has already adjudicated the claim; obtain the primary payer's EOB/ERA for reference.
2Cross-check the primary payer's payment and adjustment amounts against the secondary payer's adjustment to ensure the combined total does not exceed the allowed amount and no duplicate payments are being made.
3If the secondary payer's adjustment appears incorrect — for example, it does not account for the primary's payment or applies the wrong COB calculation — file a claim reconsideration with the primary EOB attached.
4Post the adjustment in the practice management system, ensuring the patient balance reflects only the remaining coinsurance, deductible, or copay after both payers have adjudicated.
5If the adjustment results in a zero balance and the claim is fully satisfied, close the account; if a patient balance remains, bill the patient with a statement showing both payers' adjudications.

EHR Documentation Note

Claim adjusted 23 — prior payer adjudication impact (OA); verified COB calculation against primary EOB, posted secondary adjustment, and reconciled patient balance.

Preventative Action

Always submit primary EOBs with secondary claims and maintain accurate COB records in the practice management system to prevent incorrect coordination adjustments.

Related Codes in General Adjustment

Deductible Amount

Coinsurance Amount

Co-payment Amount

The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.