COB Electronic Claims Sub-Tab

The options on the COB Electronic Claims tab work only for electronic secondary claims and accommodate 837 COB requirements.

CAUTION:

These options should never be enabled unless the payer requires them. Claim rejections can occur if these segments are present and the payer does not want them.

Field	Description
Populate 2400 CN1 contractual adjustment segment	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 (CASCO), then the allowed amount is added as the 2400 CN1 amount. The presence of the CASCO segment causes the CN1 segment to create mimicking the allowed/approved amount in the AMT*AAE segment.
Enable COB information popup in payment entry	Select this option so that during transaction entry 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)	Select this option to add a claim level AMTF2 segment. If this option is enabled and a service line patient responsible adjustment exists (CASPR), then the patient responsibility amount will be added in the 2320 AMTF2 segment. The presence of the CASPR segment causes the AMT*F2 segment to create. This option will be ignored if enabled when creating 5010 electronic secondary claims.
Populate 2330 DTP*573 claim-level adjudication date	Select this option to populate the claim-level adjudication date Loop 2330, DTP*573 for COB claims. This option is used to send other payers adjudication date at the claim level. It can be used in place of reporting the adjudication date at the service line level.
Suppress other payer detail line 2430 loop	Select this option to suppress the SVD, CAS, and DTP segments from service line Loop 2430 file types 837P and 837I. This option also suppresses service line Loop 2400 segment AMT*AAE for file type 837P. This option should be used when the COB payer doesn't want the other payer's payment detail reported at the service line level.
Populate 2320 SBR04 with primary MSP payer ID or name	Select this option to use the electronic claim form for the MSP payer ID or name.
Populate 2330B NM109 with primary Carrier/TPL Code	Select this option to populate the 2330B NM109 segment with the primary carrier code or the TPL code on secondary electronic claims. This option will default to null on an upgrade.
Populate 2430 SVD01 with primary Carrier/TPL Code	Select this option to populate the 2430 SVD01 segment with the primary carrier code or the TPL code on secondary electronic claims. This option will default to null on an upgrade.
Populate 2320 claim level approved/ allowed amounts (4010 only)	Select this option to enable or disable AAE and B6 together or independent of each other at the 2320 claim level. The 837P file type utilizes both AMTAAE and AMTB6. Options include: <none> - no payer-level option set - use the Submitter Profile option and generate an AMTB6 (Allowed Amt) segment Disable both AAE and B6 - disable both for this payer Enable AAE Approved Amt only - force the approved amount only for this payer Enable B6 Allowed Amt only - force the allowed amount only for this payer Enable both AAE and B6 - force both for this payer Note: Claim level AMTAAE is not valid in an 837I (institutional file); AMT*B6 is used for that file type. This option will be ignored if enabled when creating 5010 electronic secondary claims.
Populate 2320 CAS claim level adjustment amount	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 CASCO sums all service line level CASCO segments and adds one claim level segment with that total. Only one instance of a claim level CASCO is allowed. If multiple CASCO segments exist at the service line level with different reason codes, they are all combined in one claim level CASCO 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 CASPR sums all service line level CASPR segments and adds one claim level segment with that total. Only one instance of a claim level CASPR is allowed. Multiple service line PR adjustments are handled as described above for the CAS segment.
Prevent COB claims from being created until all line items have zero balances from previous payers	Select this option to prevent COB claims from being created unless all line items have payments from a previous payer and the balance is zero. The only exception to this rule is for non-covered payer SIMs defined in the Service Items library on the Payer tab.
Populate AMT*A8 for prior payer non-covered services	Select this option to send the 2320 AMTA8 on COB claims when the service is not covered by a prior payer for all claim types in the 5010 and 4010 format. When you enable this option: The AMTA8 populates in the claim for all prior payer non-covered SIMs as identified in the Payer tab of the Service Items Maintenance window. You can open Service Items Maintenance window from the Service Items on the Libraries in File Maintenance. Then select the Non Covered check box. The AMT*A8 equals the sum of all non-covered services on the claim Covered and non-covered services cannot be listed on the same claim
Remaining Patient Liability (AMT*EAF)	Select one of the following options: Populate 2320 AMTEAF Populate 2430 AMTEAF

The options on the COB Electronic Claims tab work only for electronic secondary claims and accommodate 837 COB requirements.

CAUTION:

These options should never be enabled unless the payer requires them. Claim rejections can occur if these segments are present and the payer does not want them.

Field	Description
Populate 2400 CN1 contractual adjustment segment	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 (CASCO), then the allowed amount is added as the 2400 CN1 amount. The presence of the CASCO segment causes the CN1 segment to create mimicking the allowed/approved amount in the AMT*AAE segment.
Enable COB information popup in payment entry	Select this option so that during transaction entry 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)	Select this option to add a claim level AMTF2 segment. If this option is enabled and a service line patient responsible adjustment exists (CASPR), then the patient responsibility amount will be added in the 2320 AMTF2 segment. The presence of the CASPR segment causes the AMT*F2 segment to create. This option will be ignored if enabled when creating 5010 electronic secondary claims.
Populate 2330 DTP*573 claim-level adjudication date	Select this option to populate the claim-level adjudication date Loop 2330, DTP*573 for COB claims. This option is used to send other payers adjudication date at the claim level. It can be used in place of reporting the adjudication date at the service line level.
Suppress other payer detail line 2430 loop	Select this option to suppress the SVD, CAS, and DTP segments from service line Loop 2430 file types 837P and 837I. This option also suppresses service line Loop 2400 segment AMT*AAE for file type 837P. This option should be used when the COB payer doesn't want the other payer's payment detail reported at the service line level.
Populate 2320 SBR04 with primary MSP payer ID or name	Select this option to use the electronic claim form for the MSP payer ID or name.
Populate 2330B NM109 with primary Carrier/TPL Code	Select this option to populate the 2330B NM109 segment with the primary carrier code or the TPL code on secondary electronic claims. This option will default to null on an upgrade.
Populate 2430 SVD01 with primary Carrier/TPL Code	Select this option to populate the 2430 SVD01 segment with the primary carrier code or the TPL code on secondary electronic claims. This option will default to null on an upgrade.
Populate 2320 claim level approved/ allowed amounts (4010 only)	Select this option to enable or disable AAE and B6 together or independent of each other at the 2320 claim level. The 837P file type utilizes both AMTAAE and AMTB6. Options include: <none> - no payer-level option set - use the Submitter Profile option and generate an AMTB6 (Allowed Amt) segment Disable both AAE and B6 - disable both for this payer Enable AAE Approved Amt only - force the approved amount only for this payer Enable B6 Allowed Amt only - force the allowed amount only for this payer Enable both AAE and B6 - force both for this payer Note: Claim level AMTAAE is not valid in an 837I (institutional file); AMT*B6 is used for that file type. This option will be ignored if enabled when creating 5010 electronic secondary claims.
Populate 2320 CAS claim level adjustment amount	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 CASCO sums all service line level CASCO segments and adds one claim level segment with that total. Only one instance of a claim level CASCO is allowed. If multiple CASCO segments exist at the service line level with different reason codes, they are all combined in one claim level CASCO 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 CASPR sums all service line level CASPR segments and adds one claim level segment with that total. Only one instance of a claim level CASPR is allowed. Multiple service line PR adjustments are handled as described above for the CAS segment.
Prevent COB claims from being created until all line items have zero balances from previous payers	Select this option to prevent COB claims from being created unless all line items have payments from a previous payer and the balance is zero. The only exception to this rule is for non-covered payer SIMs defined in the Service Items library on the Payer tab.
Populate AMT*A8 for prior payer non-covered services	Select this option to send the 2320 AMTA8 on COB claims when the service is not covered by a prior payer for all claim types in the 5010 and 4010 format. When you enable this option: The AMTA8 populates in the claim for all prior payer non-covered SIMs as identified in the Payer tab of the Service Items Maintenance window. You can open Service Items Maintenance window from the Service Items on the Libraries in File Maintenance. Then select the Non Covered check box. The AMT*A8 equals the sum of all non-covered services on the claim Covered and non-covered services cannot be listed on the same claim
Remaining Patient Liability (AMT*EAF)	Select one of the following options: Populate 2320 AMTEAF Populate 2430 AMTEAF

COB Electronic Claims Sub-Tab

Recommendations

Claims-2 Tab

COB Electronic Claims Sub-Tab

COB Electronic Claims Sub-Tab

COB Electronic Claims Sub-Tab

Setting the Optional Segments for the 837 Format

Setting the Optional Segments for the 837 Format

COB Electronic Claims Sub-Tab

Claims-2 Tab

COB Electronic Claims Sub-Tab

COB Electronic Claims Sub-Tab

COB Electronic Claims Sub-Tab

Setting the Optional Segments for the 837 Format

Setting the Optional Segments for the 837 Format