Understanding disallow code OX6 on your remittance advice

It’s important to us that you understand the way your claims are handled – including what the various codes that may appear on your remittance advice mean.

One claim adjustment code we get a lot of questions about is OX6.

What’s OX6?

OX6 is a disallow code applied to charges billed in error. This code is:

• Applied to an original claim when a provider submits a replacement or void claim
• Seen on the paper remittance advice for the original claim

Can you appeal OX6?

No, you can’t appeal the OX6 disallow code on the original claim. Instead, review the replacement claim in prism to determine if an appeal is necessary. If it is, you can follow the reviews / appeals process on the replacement claim.

To review a claim in prism:

1. Log into your prism account.
2. Under the Claims tab click Medical Claims.
3. Find the claim in question on the claims listing page. You can use the search bar in prism to enter your Claim ID or any element on the claims list page to filter your claims. When you find the right claim, click on the Claim ID link.
4. Review the resulting claim detail page where you can see line-by-line details for how your claim was processed.

To request reconsideration on the replacement claim, your first step is to submit an informal claim review. Learn how (this process is the same for all plans).