When reviewing claim payments, you may occasionally see an OA (Other Adjustment) code with the explanation: "The impact of prior payer(s) adjudication including payments and/or adjustments."
This code indicates that Select Health is acting as the secondary insurance for the member on that claim. In these cases, the primary insurance has already processed the claim, made payments or adjustments, and the Coordination of Benefits (COB) guidelines are applied accordingly.
If you would like to review how the claim was processed, you can do so by comparing the Remittance Advice (RA) received from both Select Health and the primary insurer. This will help give you a complete picture of why certain payments, balances, or adjustments were applied and ensure that your billing aligns with each payer’s policies and COB requirements.
Questions? Contact Provider Inquiries at 1-800-222-6358.