Claim Print Options When the Payer is Tertiary

Help Guide for NextGen® Enterprise PM 8

Coordination of Benefits Options

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

Help Guide for NextGen® Enterprise PM 8

UB04 and UB92 Options

Field UB04 and UB92 Options Description Exceptions: When Payer is Tertiary Tab [FL54] Prior Payment Select one of the following options: Blank Prior Payer Payments [FL55] Estimated Amount Due Select one of the following options: Blank Charge Amt minus Box 54 Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are A1 or A2. Non-Medicare Primary: Charge Amt minus Box 54 minus Box 39 if value codes are B1, B2, C1, or C2. [FL64] Document Control Number Select one of the following options: Default – No selection Blank – Use to remove a selection or no selection. Resub Ref # (from Claim Maintenance) - When this is selected, the Resubmission Reference Number in the Claims Maintenance Claims Detail “Resubmission Code field. This is an alpha numeric field with a maximum length of 26 characters. Prior Payer Ref # (from Claim Maintenance) – When this is selected the Prior Payer Resubmission Reference Number will print from the new field “Prior Payer Reference Number” in Claims M

Help Guide for NextGen® Enterprise PM 8

ADA (2019 and 2024) Form Options for Tertiary 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

1500 CMS Options (2012)

Field 1500 CMS Options (2012) Description Exceptions: When Payer is Tertiary 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 or Secondary Check Medicare when Tertiary payer is Medicaid else Payer Claim Type [1a] Insured 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 Tertiary payer's policy # + Plan Code [2 and 4] Enable Commas Select this option to separate first name, last name, and middle initial by commas in boxes 2 and 4 on the 2012 form. [4] Insured's name Select one of the following options: 'SAME' if Medicare 2nd and patient addr = insured addr; else LastName FirstName MI of insured 'SAME' if patient and insured are same; else Blank 'SAME' if patient and insured are same; else LastName FirstName MI of insured 'S

Help Guide for NextGen® Enterprise PM 8

Set Up Exceptions for a Tertiary Payer

In File Maintenance, select Libraries and then Claim Printing. The Claim Printing List window opens. Double-click the applicable library or select open menu button and select New. Select the Exceptions: When Payer is Tertiary tab. Select the claim type in the 1500 Claims, UB Claims, or the ADA Claims fields. Select Print EOB(s) when printing tertiary claim, if you want to print all EOBs when printing the tertiary claim. Select OK. Parent topic: Claim Print Options in Claim Printing Library

Help Guide for NextGen® Enterprise PM 8

Claim Print Options When the Payer is Secondary

This following sections consist of the Claim Printing options in the Exceptions: When Payer is Secondary tab: CMS 1500 (2012) UB04 & UB92 Options ADA (2019 and 2024) Form Options for Secondary Payer Coordination of Benefits Options For more information on how to set up the Claim Printing options in the Exceptions: When Payer is Secondary tab, refer to Set Up Exceptions for a Secondary Payer. CMS 1500 (2012) UB04 & UB92 Options There are several claim print options applicable to UB04 and UB92 claim form for all payers. ADA (2019 and 2024) Form Options for Secondary Payer There are several common claim print options applicable to ADA 2019 and ADA 2024 claim forms for the secondary payer. Coordination of Benefits Options Parent topic: Claim Printing Options

Claim Print Options When the Payer is Tertiary

Recommendations

Coordination of Benefits Options

UB04 and UB92 Options

ADA (2019 and 2024) Form Options for Tertiary Payer

1500 CMS Options (2012)

Set Up Exceptions for a Tertiary Payer

Claim Print Options When the Payer is Secondary

Coordination of Benefits Options

UB04 and UB92 Options

ADA (2019 and 2024) Form Options for Tertiary Payer

1500 CMS Options (2012)

Set Up Exceptions for a Tertiary Payer

Claim Print Options When the Payer is Secondary