UB92 Options

Field	UB92 Options Description Exceptions: When Payer is Primary Tab
[FL55] Estimated Amount Due	Displays the following options for [FL55] Estimated Amount Due: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2 Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2

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ADA (2019 and 2024) Form Options For Primary Payer

ADA Options Description [4] Other Dental or Medical Coverage One of the following options display the payer details when the patient has coverage under any dental or medical plan: BlankNote: If you select Blank, then nothing prints in Boxes 5-11. Dental/Medical Checks Dental box, if other coverage is the non-primary payer and the Payer Defaults 2 tab is selected. Checks Medical box when payer is primary. Note: Boxes 5-11 print with correct data for both types of coverage. [31a] Other Fee(s) – Line 1 – When zero dollar amount, display One of the following options display the fee of the other charges applicable to dentist services when the amount is zero-dollar: 0.00 Blank [31a] Other Fee(s) – Line 1 One of the following options display the fee of the other charges applicable to dentist services: Adjustments onlyIncludes all previous adjustments (payer or contractual) from all COB levels. All payer paymentsIncludes all previous payer payments from all COB levels. All payer payments + Adj

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UB92 Options

Field UB92 Options Description Exceptions: When Payer is Primary Tab [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2 Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2 Parent topic: Set Up Exceptions for the Primary Payer

Help Guide for NextGen® Enterprise PM 8

UB92 Options

Field UB92 Options Description Exceptions: When Payer is Primary Tab [FL55] Estimated Amount Due Displays the following options for [FL55] Estimated Amount Due: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2 Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2 Parent topic: Claim Print Options When the Payer is Primary

Help Guide for NextGen® Enterprise PM 8

UB92 Options

Field UB92 Options Description Exceptions: When Payer is Primary Tab [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2 Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2 Parent topic: Claim Print Options When the Payer is Primary

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UB04 & UB92 Options

Field UB04 & UB92 Options Description Exceptions: When Payer is Secondary Tab [FL 50-53] Blank if Medicare Primary Suppress primary payer information in these fields if Medicare is primary. When this option is selected, the secondary and tertiary payer information in FL 50-66 moves to the primary and secondary positions (Lines A & B). [FL54] Prior Payment One of the following options displays prior payment: Blank Blank if Medicare is Prim Prior Payer Payments [FL55] Estimated Amount Due One of the following options displays estimated amount that is due: Blank Charge Amt minus Box 54 Charge Amt minus Box 54 minus Value Code amounts (Deductible and Coinsurance only) Charge Amt minus first Value Code amt (share of cost only) Charge Amt minus Value Code amounts (Deductible and Coinsurance only) Enc Rate SIM amount [FL64] Document Control Number One of the following options displays document control number: Default – No selection Blank – Use to remove a selection or no selection. Resub Ref

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UB04 & UB92 Options

Field UB04 & UB92 Options Description Exceptions: When Payer is Secondary Tab [FL 50-53] Blank if Medicare Primary Select this option to suppress primary payer information in these fields if Medicare is primary. When this option is selected, the secondary and tertiary payer information in FL 50-66 moves to the primary and secondary positions (Lines A & B). [FL54] Prior Payment Select one of the following options: Blank Blank if Medicare is Prim Prior Payer Payments [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Charge Amt minus Box 54 minus Value Code amounts (Deductible and Coinsurance only) Charge Amt minus first Value Code amt (share of cost only) Charge Amt minus Value Code amounts (Deductible and Coinsurance only) Enc Rate SIM amount [FL64] Document Control Number Select one of the following options: Default – No selection Blank – Use to remove a selection or no selection. Resub Ref # (from Claim Maintenance) - Select to print the Re

UB92 Options

Recommendations

ADA (2019 and 2024) Form Options For Primary Payer

UB92 Options

UB92 Options

UB92 Options

UB04 & UB92 Options

UB04 & UB92 Options

ADA (2019 and 2024) Form Options For Primary Payer

UB92 Options

UB92 Options

UB92 Options

UB04 & UB92 Options

UB04 & UB92 Options