Overview of Electronic Secondary Claims (COB)

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Electronic Secondary Claims (COB) Overview-NextGen® PM Appendix A- Troubleshooting MSP (Medicare Secondary Payer) Rejections o CO16-This claim lacks additional information to adjudicate this claim MSP reason code submitted does not match what Medicare has on file due to an incorrect MSP code submission Update the valid MSP code in Patient Insurance Maintenance>Details 2 tab for each encounter effected and rebill o OTAF (Obligated to Accept in Full) record is missing Medicare denial for missing record Verify Payer Master>System>Electronic Claims> Electronic Secondary>Check box “Populate 2400 CN1 contractual adjustments” This should be checked for any Medicare type pay Appendix B-Defects and Enhancements DT#47641/Problem6809-Fixed 5.6-Multiple transactions being applied which creates additional transaction display pages. (i.e. Page 1 of 3): Whenever more than one type of transaction (payment) is applied to the same line item at different intervals, each COB window entry is added together incorrectly. Examples where multiple transactions can be applied: o Split Primary Claim Payments o Payment comes in and only applies to specified line items (not all) and is posted. Another payment is received (possibly same day) applied to other line item(s) o Denied Claims o Zero payment applied first. Claims appeal results in payment DT#44501/Problem 7248/Fixed 5.6- “Allowed” amount field within the COB window is not editable. If not entered during transaction posting or populated incorrectly by a contract loaded DT#42957Problem 4762-TBD-Encounter>Ins maintenance>Ability to make the MSP reason code a required field DT#45649/Problem/Fixed 5.6- Claim Bundling of like CPT codes-Utilizing “Do Not Sum Units for CPT 4 Code” settings in Practice preferences, Payers, or SIM DT#55372/Problem 9386-Scheduled 5.6SP2-Encounter Rate Billing & Electronic Secondaries 1. Encounter Rate Primary (837I/UB) and Secondary (837P/1500) 2. Primary FFS (837P/1500) and Encounter Rate Secondary (837I/UB) DT#46804/Problem 3043–Scheduled 5.6SP2-COB: Need an edit and/or warning message for missing adjudication date DT#45648/Problem 8238-TBD-Change COB Logic popup to only POP up when secondary insurance is attached and secondary insurance is set to paper. NEXTGEN® Healthcare, Inc. EPMClaims © Copyright 2010 All Rights Reserved Confidential and Proprietary DO NOT COPY V5.6SP1 Sept2010 Page 28 of 29
Electronic Secondary Claims (COB) Overview-NextGen® PM Appendix C- Handling Specialized Transactions (PQRI) PQRI- Physicians Quality Reporting Initiatives Must post as a $0.00 charge in order for the COB functionality to work as designed. When applying primary payment received, enter an allowed amount of 0.00 on the corresponding PQRI transaction and enter appropriately for any other billable charges involved. Within the COB window, do not add any reason codes and/or reason values associated to the PQRI rowonly to other chargeable line items with balances. Access Balance Control and check “R” for re-bill alongside the corresponding Ins2 Amt column of the PQRI SIM row so it will be included along with any other qualifying charge transactions(s) within the secondary electronic file. NEXTGEN® Healthcare, Inc. EPMClaims © Copyright 2010 All Rights Reserved Confidential and Proprietary DO NOT COPY V5.6SP1 Sept2010 Page 29 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 27: NextGen® Portal Electronic Seconda

Overview of Electronic Secondary Claims (COB)

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