Denial Code 23: The Impact of Prior Payer Adjudication (Easy Explanation + Examples)
What is Denial Code 23?
Denial Code 23 means:
The claim is denied because the primary insurance already paid an amount equal to or more than what the secondary insurance would allow.
In simple words:
• Secondary insurance checks the claim
• If primary already paid enough (or more)
• Secondary will not pay the remaining balance
• So the claim gets denied with Code 23
Why Denial Code 23 Happens
Denial 23 commonly occurs when:
• The secondary allowed amount is less than (or equal to) the primary paid amount.
• Secondary insurance feels:
“Primary already paid enough, so we don’t owe anything.”
| Term | Meaning |
| Billed Amount | Amount charged by provider |
| Allowed Amount | Amount insurance accepts as payable |
| Paid Amount | Amount insurance paid |
| PTR (Patient Responsibility) | Coinsurance/Deductible/Copay |
How Secondary Insurance Pays (Or Denies) – 3 Simple Examples
Example 1: Secondary Pays Remaining Balance
• Billed Amount: $90
• Primary Allowed: $20
• Primary Paid: $16
• Coinsurance: $4
Now secondary processes claim:
• Secondary Allowed: $20
• Primary already paid: $16
• Secondary pays remaining: $4
Result: Secondary pays $4
Example 2: Secondary Pays Partial + Denies Balance (Denial 23)
• Billed Amount: $120
• Primary Allowed: $30
• Primary Paid: $24
• Coinsurance: $6
Secondary processes claim:
• Secondary Allowed: $28
• Primary already paid: $24
• Secondary pays only: $4
• Remaining coinsurance: $2 denied
Denial: $2 denied with Code 23
Result: Secondary pays $4 and denies $2 (Code 23)
Example 3: Secondary Fully Denies (Denial 23)
• Billed Amount: $100
• Primary Allowed: $25
• Primary Paid: $20
• Coinsurance: $5
Secondary processes claim:
• Secondary Allowed: $20
• Primary already paid: $20
• Secondary pays nothing
Denial: Balance denied due to Code 23
Result: Secondary denies entire balance (Code 23)
Important Note
If you receive Denial Code 23 from Primary Insurance and there is no payment, then:
You must call primary insurance and confirm:
• exact denial reason
• whether claim was processed correctly
On-Call Scenario (Denial 23 Call Script)
Use this simple flow when calling insurance:
Step 1: Confirm denial
“Claim denied because primary paid more than secondary allowed amount.”
Step 2: Ask denial details
- May I get the denial date?
- What is the allowed amount?
- How much did the primary insurance pay? (verify in your system)
Step 3: Compare amounts
Now check:
Is Primary Paid ≥ Secondary Allowed Amount?
Decision Process
If YES (Primary Paid is Greater or Equal)
Action:
• Ask for Claim # and Reference #
• Write off the balance
Reason:
Secondary insurance will not pay.
If NO (Primary Paid is Less)
Action:
Request reprocessing:
“Could you please reprocess the claim since primary paid amount is less than your allowed amount?”
Then ask:
• What is the TAT (Turnaround Time) for reprocessing?
• Take Claim # and Call Reference #
• Set follow-up for TAT date
Actions to Take for Denial Code 23 (Quick Summary)
When to Write Off
Write off balance if:
• Primary Paid ≥ Secondary Allowed
When to Follow Up
Follow up if:
• Primary Paid < Secondary Allowed
• Rep agrees to reprocess the claim
• Set follow-up for rep’s TAT
Final Conclusion
Denial Code 23 is not an error most of the time. It simply means:
Primary already paid enough
Secondary does not owe more
Claim denied under Code 23
