Overview of Electronic Secondary Claims (COB)

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Electronic Secondary Claims (COB) Overview-NextGen® PM Master Files >System Tab >System Tab >COB Electronic Claims The COB Electronic Claims sub-tab offers several options. These options should only be enabled on NextGen® advisement. As a System tab option, all payers across the enterprise will be affected. Populate 2400 CN1 contractual adjustment segment o Select this option to add a service line CN1 segment (2400). This amount is also referred to as the OTAF (obligated to accept in full) amount. If this option is enabled and a service line contractual adjustment exists (CAS*CO), then the allowed amount is added as the 2400 CN1 amount. The presence of the CAS*CO segment causes the CN1 segment to create mimicking the allowed/approved amount in AMT*AAE Medicare payers should have this enabled Enable COB Window information popup in payment entry o Select this option so when this payer is secondary, the Coordination of Benefits Information window automatically displays when the user tabs out of the Reason field for the last transaction detail row Populate 2320 AMT*F2 patient responsibility amount segment (4010 only) o Select this option to add a claim level AMT*F2 segment. If this option is enabled and a service line patient responsible adjustment exists (CAS*PR), the patient responsibility amount will be added in 2320 AMT*F2. The presence of the CAS*PR segment causes the AMT*F2 segment to create Populate claim-level adjudication date in 2330B DTP*573 o Update description to say 2330B DTP*573 Suppress other payer detail line 2430 loop o No change. Functions the same way in 5010 Populate 2320 SBR04 with primary MSP payer ID or name o Selection this option to add the primary payer‟s MSP payer ID or name into 2320 SBR04 NEXTGEN® Healthcare, Inc. EPMClaims © Copyright 2010 All Rights Reserved Confidential and Proprietary DO NOT COPY V5.6SP1 Sept2010 Page 8 of 29
Electronic Secondary Claims (COB) Overview-NextGen® PM Master Files >System Tab >System Tab >COB Electronic Claims (cont’d) Populate 2320 claim level approved/allowed amounts (4010 only) o Select this option to add claim level (2320) AMT segments if the comparable segment exists at the service line level. This option will be sensitive to file format (professional or institutional) and only inserts segments appropriate to the file type Professional file added segments: 2320 AMT*AAE (sum of all 2400 AMT*AAE segments) 2320 AMT*B6 (sum of all 2400 AMT*AAE segments) 2320 AMT*F2 (sum of all 2430 CAS*PR segments) Institutional file added segments: 2320 AMT*F2 (sum of all 2430 CAS*PR segments) Populate 2320 CAS claim level adjustment amount (4010 only) o Select this option to add claim level (2300) CAS segments if the comparable segment exists at the service line level. These segments are the same for the different file formats (professional or institutional). Only one claim-level CAS segment is allowed per individual group code. The two most common segments are listed below: 2320 CAS*CO sums all service line level CAS*CO segments and adds one claim level segment with that total. Only one instance of a claim level CAS*CO is allowed. If multiple CAS*CO segments exist at the service line level with different reason codes, they are all combined in one claim level CAS*CO with the reason codes repeating in fields 02, 05, 08, 11, 14, and 17. The corresponding amounts are placed in fields 03, 06, 09, 12, 15, and 18 2320 CAS*PR sums all service line level CAS*PR segments and adds one claim level segment with that total. Only one instance of a claim level CAS*PR is allowed. Multiple service line PR adjustments are handled as described above for the CAS segment NEXTGEN® Healthcare, Inc. EPMClaims © Copyright 2010 All Rights Reserved Confidential and Proprietary DO NOT COPY V5.6SP1 Sept2010 Page 9 of 29
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Page 5 and 6: Submitter Profile Electronic Second
Page 7: 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
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Overview of Electronic Secondary Claims (COB)

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