Overview of Electronic Secondary Claims (COB)

More documents

Recommendations

Info

Generating Secondary EDI Files Electronic Secondary Claims (COB) Overview-NextGen® PM Primary claims can still be generated without affecting secondary claims. When ready to generate secondary claims, access the EDI File icon, click on the “Advanced” tab. Deselect the “Primary” and “Tertiary” options to produce secondary claims in an EDI file separately. BBP (Background Business Processer) Uncheck Primary and Tertiary field to generate a Secondary file separately. Don‟t forget your star employee “Billy Bob Processer” (BBP). BBP is dependent upon your instructions and guidance on assignments. When considering queuing up Batch Billing and EDI files in the same run: Make sure your BBP is set up only to include “Primary” claims and not secondary‟s too, since it requires monitoring of the Claim Production Status report for any out of balance COB claims that may be edited. Generating secondary claim files should be done manually until version 5.5.28.28 where the edits are included in the Claim Edit Library. Remember; treat BBP as you would any other employee. Check in and verify work is completed correctly and in the time you specified on a consistent basis. If BBP jobs fail, verify the instructions you‟ve given match what BBP is performing. NEXTGEN® Healthcare, Inc. EPMClaims © Copyright 2010 All Rights Reserved Confidential and Proprietary DO NOT COPY V5.6SP1 Sept2010 Page 26 of 29
NextGen® Portal Electronic Secondary Claims (COB) Overview-NextGen® PM COB functionality not currently supported may require editing secondary claims outside of the NextGen® application. Some clearinghouses allow you to edit secondary electronic claims with the correct information. Otherwise, as a workaround, NextGen® offers a free product called the NextGen® Portal. Instances requiring secondary claims to be edited outside of the NextGen® application: DT Reviewed-Not Scheduled/Problem 12370-837I UB Secondary Billing Missing COB Total Submitted Charges-2320 AMT*T3 segment DT#55372/Problem 9386-Scheduled 5.6SP2-Encounter Rate Billing & Electronic Secondary Encounter Rate Primary (837I/UB) and Secondary (837P/1500) Primary FFS (837P/1500) and Encounter Rate Secondary (837I/UB) Training for the NextGen® Portal is a non-billable service offered as a separate one hour WebEx designed for an organization‟s Core Group or Super Users. Working knowledge of payment processing, including the use of the COB window is a prerequisite to Portal training. Log a support ticket specifically requesting COB Portal training and your ticket will be routed to an EDI Systems Analyst for scheduling. NEXTGEN® Healthcare, Inc. EPMClaims © Copyright 2010 All Rights Reserved Confidential and Proprietary DO NOT COPY V5.6SP1 Sept2010 Page 27 of 29
Page 1 and 2: Electronic Secondary Claims (COB) O
Page 5 and 6: Submitter Profile Electronic Second
Page 7 and 8: Payer Master File Electronic Second
Page 11 and 12: Free Text Line Item Reason Codes El
Page 13 and 14: Allowed Amount- Payment Entry Elect
Page 15 and 16: Balancing COB Window Electronic Sec
Page 17 and 18: Continue that same process for each
Page 19 and 20: Editing Batch and COB Window As lon
Page 25: Electronic Secondary Claims (COB) O
Page 29: Electronic Secondary Claims (COB) O

Overview of Electronic Secondary Claims (COB)

Create successful ePaper yourself

Delete template?

Save as template?