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.

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.

When viewing COB1, COB2, and COB3 data, you can edit the following fields:

• Include - Check to send the transaction to a secondary payer for payment.
• Allowed - Amount paid by the payer for the transaction.
• Rsn Cd - Reason Code
• Rsn Amt - The dollar amount associated with the reason code.
• Payment - The total amount paid on the transaction.

All other columns can be edited from the transaction detail row on the Payment Entry window.

The information in the Coordination of Benefits Information window will not create actual transactions nor will it append to the real transactions. The data is saved in separate tables for use only when creating secondary claims.

The COB billing process enables you to create balanced secondary claims. When you bill a secondary claim, the system uses the mostly recently modified transaction, which enables you to bill encounters with split payments and to easily figure out what needs to be done to balance.