Overview of Electronic Secondary Claims (COB)

Electronic Secondary Claims (COB) Overview-NextGen® PM
Electronic Secondary Claims (COB) Set-Up
Libraries
Libraries>Reason Codes
Reason Code Libraries provide the ability to configure business rules which can be used to automate
electronic transaction posting.
The HIPAA X12 Standard Reason Codes Library (File Maintenance > Libraries > Reason Codes) is
preloaded in the NextGen® application and contains industry Standard Reason Codes. Only HIPAA X12
Standard Reason Codes are permitted for electronic secondary claims.
Libraries> Reason Codes> Reason Code Priority
Reason Code Priority has two main purposes:
1. To determine the order reason codes will display in the transaction posting screen & COB window
during payment posting
2. To determine which business rules take priority when multiple reason codes are used on one line
item.
For example, if one code indicates a transaction status of “Appeal” and the other code allows the
remaining balance to be moved to the next responsible payer, the system will process the reason codes
according to which reason code appears first in the priority list.
Select a Reason Code Library. Right-click and select Reason Code Priority. To move a code to the top
or to the bottom of the list, highlight the code and select the blue “up” or “down” double-arrows. Use the
blue “up” and “down” single-arrow to move a code ine by line.
NEXTGEN® Healthcare, Inc. EPMClaims
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