Enter the Allowed Amount in the COB Information Window

Help Guide for NextGen® Enterprise PM 8

Generating Electronic Secondary Claims from Manually Posted Primary Payments

You can generate HIPAA-compliant electronic secondary claims from manually posted primary payments. A Coordination of Benefits Information window is available from the Payment Entry window for the collection of individual reason codes and adjustment amounts for each detail row on the Payment Entry window. Note: To show all line items on the Payment Entry window, enable the Show All Line Items check box. The amounts from the CPT4 code, billed amount (charge amount), payment amount, allowed amount, and reason codes default from the transaction detail of the Payment Entry window to the Coordination of Benefits Information window. The adjudication date defaults from the Adjudication Date field on the payment batch header (Batch Maintenance window), if the field contains a date. When you select the COB button on the Payment Entry window, the Coordination of Benefits Information window opens. Note: The reason code amount defaults to the Coordination of Benefits Information window if only one

Help Guide for NextGen® Enterprise PM 8

Access the COB Information Window

After the batch is posted, the Coordination of Benefits Information window can only be accessed from the Transactions tab on the patient chart in the Encounters tab. From the Transactions tab, right click and select Transaction Detail. To access the Coordination of Benefits Information window, do one of the following: Select the COB button on the Payment Entry window. Select the Enable COB information popup in payment entry option in the Payers master file. In File Maintenance, select Master Files > Payers. On the Payers List window, double-click the applicable payer. On the Modify Payers Information window, select System > COB Electronic Claims. Enable the Enable COB information popup in payment entry check box. The Coordination of Benefits Information window pops up when you tab out of the Reasons (code) field for the last transaction detail row on the Payment Entry window. Parent topic: Coordination of Benefits Electronic and Manual Processing

Help Guide for NextGen® Enterprise PM 8

Generating Secondary Electronic Claims

If you are using electronic remittances, you can generate a secondary electronic claim for COB-specific 837 segments. Setting the Optional Segments for the 837 Format Enable Segments for Claim-level Approved Amounts and Adjustments Display the Family Planning Indicator on All Claims Run Claim Edits on Appointments or Encounters Force the Secondary Claim to Bill to the Primary Claim Provider Exempt Patient Co-Payments Run the Consolidation Same Day Claims Process Using Twelve Diagnoses for Electronic Claims Force Claims to Paper by ICD Code Setting Up a Release of Information Default Parent topic: Coordination of Benefits Electronic and Manual Processing

Help Guide for NextGen® Enterprise PM 8

Coordination of Benefits Electronic and Manual Processing

You can view information on all the payers for EDI claims in the Coordination of Benefits Information (COB) window. The Coordination of Benefits Information window provides information on all payers for EDI claims. This includes primary, secondary, and tertiary payers for 837I, 837P, and 837D claims. A summary of all COB activity by charge lines on an encounter for all previous transactions will display on the Coordination of Benefits Information window. When viewing COB1, COB2, COB 3, or All Payer data fields are editable by transaction line. ERA File When the ERA file contains a CAS segment with a charge line that has two identical reason codes, one CAS segment is created for the two identical reason codes in the 837 file. The reason codes are combined and display on a single line in the 837 file. Example: The COB window contains CO45 $50 and CO45 $25 and a PR2 on a single service line, the CAS segment will create CAS*CO*45*75 in the 837 file to represent the CO45 amounts and continu

Help Guide for NextGen® Enterprise PM 8

Set Up a COB Imbalance Warning

You can setup a practice preference to issue a warning when the COB allowed or billed amount is out of balance. On the Admin menu and select Preferences and then Practice. The Practice Preferences window opens. Select Transactions from the Preference List. In the COB Windows Options section of the window, enable one or more of the following check boxes: Warn on COB imbalance with allowed amount Warn on COB imbalance with billed amount After you enable one of the check boxes, and close the Coordination of Benefits Information window, a balance check is performed on the COB information. If the information does not balance, then one or both of the following warning messages appear if the allowed amount or billed amount is out of balance: Paid amount and patient responsible amounts do not equal allowed amount. Do you want to continue? All payments and adjustments do not equal billed amount. Do you want to continue? Parent topic: 277 File

Help Guide for NextGen® Enterprise PM 8

COB Balancing Using the 5010 Format

The following calculations explain how COB is balanced using the 5010 format: Determined By Calculation Payer The Allowed Amount uses the prior payer's payment information coupled with adjustment information in the CAS segments in this loop. The Allowed Amount = the prior payer payment + the sum total of all patient responsible adjustment amounts (in loop 2320) The patient responsible adjustments are identified by use of the Category Code PR in CAS01. Provider The Allowed Amount uses the prior payer's payment information coupled with the Remaining Patient Liability AMT segments. The Allowed Amount = the prior payer payment + the Remaining Patient Liability AMT amount Parent topic: 277 File

Enter the Allowed Amount in the COB Information Window

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Generating Electronic Secondary Claims from Manually Posted Primary Payments

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COB Balancing Using the 5010 Format