Claim Print Options When the Payer is Secondary

Help Guide for NextGen® Enterprise PM 8

Set Up Exceptions for a Secondary Payer

The Claim Printing options available for the 1500 form on the Exceptions: When Payer is Secondary tab apply only when the payer associated with the library is the secondary payer. In File Maintenance, select Libraries and then select Claim Printing. The Claim Printing List window opens. Double-click the library or select Open Menu, and then select New. Select Exceptions: When Payer is Secondary. Select the claim type in 1500 Claims, UB Claims, and ADA Claims. Select OK. Parent topic: Claim Print Options in Claim Printing Library

Help Guide for NextGen® Enterprise PM 8

UB04 & UB92 Options

Field UB04 & UB92 Options Description Exceptions: When Payer is Secondary Tab [FL 50-53] Blank if Medicare Primary Suppress primary payer information in these fields if Medicare is primary. When this option is selected, the secondary and tertiary payer information in FL 50-66 moves to the primary and secondary positions (Lines A & B). [FL54] Prior Payment One of the following options displays prior payment: Blank Blank if Medicare is Prim Prior Payer Payments [FL55] Estimated Amount Due One of the following options displays estimated amount that is due: Blank Charge Amt minus Box 54 Charge Amt minus Box 54 minus Value Code amounts (Deductible and Coinsurance only) Charge Amt minus first Value Code amt (share of cost only) Charge Amt minus Value Code amounts (Deductible and Coinsurance only) Enc Rate SIM amount [FL64] Document Control Number One of the following options displays document control number: Default – No selection Blank – Use to remove a selection or no selection. Resub Ref

Help Guide for NextGen® Enterprise PM 8

ADA (2019 and 2024) Form Options for Secondary Payer

ADA Options Description [4] Other Dental or Medical Coverage One of the following options display the payer details when the patient has coverage under any dental or medical plan: BlankNote: If you select Blank, then nothing prints in Boxes 5-11. Dental/Medical Checks Dental box, if other coverage is the non-primary payer and the Payer Defaults 2 tab is selected. Checks Medical box when payer is primary. Note: Boxes 5-11 print with correct data for both types of coverage. [31a] Other Fee(s) – Line 1 – When zero dollar amount, display One of the following options display the fee of the other charges applicable to dentist services when the amount is zero-dollar: 0.00 Blank [31a] Other Fee(s) – Line 1 One of the following options display the fee of the other charges applicable to dentist services: Adjustments onlyIncludes all previous adjustments (payer or contractual) from all COB levels. All payer paymentsIncludes all previous payer payments from all COB levels. All payer payments + Adj

Help Guide for NextGen® Enterprise PM 8

Coordination of Benefits Options

Field Coordination of Benefits Options Description Exceptions: When Payer is Secondary Tab Print EOB(s) when printing secondary claim Select this option to print all EOBs when printing the secondary claim. Parent topic: Claim Print Options When the Payer is Secondary

Help Guide for NextGen® Enterprise PM 8

CMS 1500 (2012)

Field CMS 1500 (2012) Options Description Exceptions: When Payer is Secondary Tab [1] Insured's program Select one of the following options: <none> Blank Use Legacy Standards Current Program with X Current Program with P Other if Medicare is Primary If Medicaid is secondary to Medicare, check both Medicare and Medicaid Check Medicare when Secondary payer is Medicaid else Payer Claim Type [1a] Insured's ID number Select one of the following options: <None> Blank Use Legacy Standards Current payer's insured's policy # Insured's override # if not blank; else insured's policy # Social Security Nbr Primary insured's policy number Secondary payer's policy # + Plan Code Primary payer's policy # + Plan Code [2 and 4] Enable Commas Select this option to delimit first, last and middle initial by commas. [4] Insured's name Select one of the following options: 'SAME' if Medicare 3rd and patient addr = insured addr; else LastName FirstName MI of insured 'SAME' if patient and insured are same; else

Help Guide for NextGen® Enterprise PM 8

Claim Print Options When the Payer is Primary

This following sections consist of the Claim Printing options in the Exceptions: When Payer is Primary tab: 1500 CMS Options (2012) UB92 Options ADA (2019 and 2024) Form Options For Primary Payer For more information on how to set up the Claim Printing options in the Exceptions: When Payer is Primary tab, refer to Set Up Exceptions for the Primary Payer. 1500 CMS Options (2012) UB92 Options ADA (2019 and 2024) Form Options For Primary Payer There are several common claim print options applicable to ADA 2019 and ADA 2024 for the primary payer. Parent topic: Claim Printing Options

Claim Print Options When the Payer is Secondary

Recommendations

Set Up Exceptions for a Secondary Payer

UB04 & UB92 Options

ADA (2019 and 2024) Form Options for Secondary Payer

Coordination of Benefits Options

CMS 1500 (2012)

Claim Print Options When the Payer is Primary

Claim Print Options When the Payer is Secondary

Set Up Exceptions for a Secondary Payer

UB04 & UB92 Options

ADA (2019 and 2024) Form Options for Secondary Payer

Coordination of Benefits Options

CMS 1500 (2012)

Claim Print Options When the Payer is Primary