COB Balancing 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

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

Help Guide for NextGen® Enterprise PM 8

Enter the Allowed Amount in the COB Information Window

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 Processing

Help Guide for NextGen® Enterprise PM 8

Enter the Allowed Amount in the COB Information Window

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. Payment Entry Window 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 Processing

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

File Maintenance Help for NextGen® Enterprise

Practices Preferences for Transactions

You can set default values for certain fields in the Payment Entry window for your practice. The table describes the preferences that you can set for transactions in your practice. Field Description Default Transaction Spreading Select the Patient or Third Party transaction source, and then select one of the following options: First In/ First Out – Select this option to start payments from the oldest line items to the latest. First In/ First Out - Pat Resp Date – Select this option for transaction source patient to spread payment and adjustment transactions to detail line items by the earliest patient responsibility date. Weighted distribution – Select this option to apply weighted percentage to all line items. Reason Codes Options You can select the following reason code options: Default Reason Code Library – Select a library for all payers without a specific library attached at the payer master level. You can create and modify reason code libraries in the Libraries section of File Ma

COB Balancing Using the 5010 Format

Recommendations

Set Up a COB Imbalance Warning

COB Balancing Using the 5010 Format

Enter the Allowed Amount in the COB Information Window

Enter the Allowed Amount in the COB Information Window

Set Up a COB Imbalance Warning

Practices Preferences for Transactions

Set Up a COB Imbalance Warning

COB Balancing Using the 5010 Format

Enter the Allowed Amount in the COB Information Window

Enter the Allowed Amount in the COB Information Window

Set Up a COB Imbalance Warning

Practices Preferences for Transactions