Auto-Balancing the CAS Segment on Secondary/Tertiary Claims

When an encounter rate charge is added during the billing process for a non-primary ER payer, the prior payer's billed amount does not match and the secondary/tertiary electronic claim is thrown out of balance. This causes the secondary/tertiary claim to be rejected by the clearinghouse or payer. To address this situation, the system can automatically insert a value in the CAS segment on the claim.

The What Reason code is sent in the CAS segment to auto balance the claim? option is available on the Claims tab of the Encounter Rate Billing library, under the Secondary Electronic Claims and Tertiary Electronic Claims sections.

To auto-balance the variance amount on COB claims, select a code from the HIPAA X12 Standard Reason Codes library.

The selected reason code and the variance amount populate the CAS segment on COB electronic claims. This keeps the COB claim in balance and prevents the need for manual manipulation.

The secondary and tertiary options function independently. For example, one reason code can be selected in the Secondary Electronic claims section, and a different reason code can be selected in the Tertiary Electronic claims section.