NextGen Knowledge Center

Set Up the COB Claims Tab

The COB Claims tab on the Encounter Rate Billing Library Maintenance window defines whether or not payers that may be subsequent to an encounter rate payer require the ER SIM code on their secondary/tertiary claims.

For example, Medicare requires an Encounter Rate SIM code, or pay code, on qualified FQHC claims. Medicare then pays on that ER SIM. To create a balanced electronic secondary claim, the Medicare ER SIM must appear on the secondary claim with the appropriate CAS segments.

In the case where the primary is an encounter rate payer and the secondary is not, but the secondary needs to see the ER SIM from the primary payer on the claim, the setup can be either of the following:
  • Setup the Encounter Rate Library for the primary payer to insert the ER SIM as a charge, so the charge can be flagged to bill to the next payer.
  • Setup the Encounter Rate Library for the primary payer to insert the ER SIM on Encounter Maintenance, and then setup an ER Library for the secondary payer to insert a $0.00 ER SIM into Encounter Maintenance when the Valid Payer = the primary payer and COB = 2.

To set up COB claim rules for subsequent payers to the ER payer, do the following:

  1. Open the Encounter Rate Billing library.
    The Encounter Rate Billing Library Maintenance window opens.
  2. Select the COB Claims tab.

  3. To indicate that all payers subsequent to the ER payer require the ER SIM code on their secondary/tertiary claims, select the Subsequent Payers require Enc Rate SIM check box.
    The Except Payers that do not accept Encounter Rate SIM section becomes available.
  4. To create an exception list of payers that do not require the ER SIM code on their secondary/tertiary claims, select Open Folder .
    The Payers window opens.
  5. In the Financial Class field, do one of the following:
    • Leave blank to list all payers.
    • Select a financial class to list payers within a specific class only.
    The Available section on the left lists all payers, or payers within the selected financial class.
  6. To add a payer to the exception list, select it in the Available section on the left, and then select Add . The payer moves to the Included section.
  7. To remove a payer from the exception list, select it in the Included section on the right, and then select Remove . The payer moves to the Available section.
  8. To save changes and close the window, select OK.
    The Subsequent Payers require Enc Rate SIM check box becomes unavailable and payers in the exception list display in the Except Payers that do not accept Encounter Rate SIM section.
  9. To save changes and close the window, select OK.