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.
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Help Guide for NextGen® Enterprise PM 8
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 FileCOB Balancing Using the 5010 Format
Help Guide for NextGen® Enterprise PM 8
If the primary payment allowed amount was posted incorrectly or left blank, you cannot edit the amount on the Payment Entry window, but you can correct it using the following procedure: On the Payment Entry window, select the COB button. The Coordination of Benefits Information window appears. Enter the correct amount in the Allowed column. Note: The allowed amount is required in the secondary file to balance, so if your COB does not list an allowed amount, you must enter the charge amount as the allowed amount. Select OK. The amount is pulled into the 837 file for secondary electronic claims processing. Parent topic: Coordination of Benefits Electronic and Manual ProcessingEnter the Allowed Amount in the COB Information Window
File Maintenance Help for NextGen® Enterprise 8
The following table describes the fields located in the Transaction Practice Preferences. Default Transaction Spreading Field Description Transaction Source Select Patient or Third Party and then select one of the FIFO or weighted options. Note: Users can also spread using the FIFO methods by right-clicking on thePayment Entry window. First In/ First Out – (FIFO) applies payments to the oldest line items, until the payment is disbursed. First In/ First Out - Pat Resp Date – Select Patient and then select this option to spread payment and adjustment transactions to detail line items by the earliest patient responsibility date. Weighted distribution – applies a weighted percentage to all line items. Reason Codes Options Field Description Default Reason Code Library Select a default reason code library, which is used for all payers who do not have a specific library attached to them at the payer master level. You can create and modify reason code libraries in the Libraries section of FileTransactions Practice Preferences Descriptions
Help Guide for NextGen® Enterprise PM 8
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 ProcessingAccess the COB Information Window
File Maintenance Help for NextGen® Enterprise 8
The Billing Options tab is used to specify which Place of Service code and ICD codes should be used on claims when multiple Behavioral Health charges on an encounter each have different codes. It also allows selection of an adjustment reason code for auto-balancing a variance amount on COB claims. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. From the list, double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Billing Options tab. Complete the fields to set up Billing Options. For more information on each field, see Billing Options Field Descriptions. To save changes and close the window, select OK. Billing Options Field Descriptions Parent topic: Behavioral Health Billing LibrarySet Up Billing Options
Help Guide for NextGen® Enterprise PM 8
The Billing Options tab is used to specify which Place of Service code and ICD codes should be used on claims when multiple Behavioral Health charges on an encounter each have different codes. It also allows selection of an adjustment reason code for auto-balancing a variance amount on COB claims. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. From the list, double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Billing Options tab. Complete the fields to set up Billing Options. For more information on each field, see Billing Options Field Descriptions. To save changes and close the window, select OK. Billing Options Field Descriptions Parent topic: Add or Modify a Behavioral Health Billing Library