Coordination of Benefits Electronic and Manual Processing

Help Guide for NextGen® Enterprise PM 8

Coordination of Benefits Electronic and Manual Processing

You can view information on all the payers for EDI claims in the Coordination of Benefits Information (COB) window. The Coordination of Benefits Information window provides information on all payers for EDI claims. This includes primary, secondary, and tertiary payers for 837I, 837P, and 837D claims. A summary of all COB activity by charge lines on an encounter for all previous transactions will display on the Coordination of Benefits Information window. When viewing COB1, COB2, COB 3, or All Payer data fields are editable by transaction line. ERA File When the ERA file contains a CAS segment with a charge line that has two identical reason codes, one CAS segment is created for the two identical reason codes in the 837 file. The reason codes are combined and display on a single line in the 837 file. Example: The COB window contains CO45 $50 and CO45 $25 and a PR2 on a single service line, the CAS segment will create CAS*CO*45*75 in the 837 file to represent the CO45 amounts and continu

Help Guide for NextGen® Enterprise PM 8

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. Note: To show all line items on the Payment Entry window, enable the Show All Line Items check box. 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. Note: The reason code amount defaults to the Coordination of Benefits Information window if only one

Help Guide for NextGen® Enterprise PM 8

Generating Secondary Electronic Claims

If you are using electronic remittances, you can generate a secondary electronic claim for COB-specific 837 segments. Setting the Optional Segments for the 837 Format Enable Segments for Claim-level Approved Amounts and Adjustments Display the Family Planning Indicator on All Claims Run Claim Edits on Appointments or Encounters Force the Secondary Claim to Bill to the Primary Claim Provider Exempt Patient Co-Payments Run the Consolidation Same Day Claims Process Using Twelve Diagnoses for Electronic Claims Force Claims to Paper by ICD Code Setting Up a Release of Information Default Parent topic: Coordination of Benefits Electronic and Manual Processing

Help Guide for NextGen® Enterprise PM 8

Access the COB Information Window

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 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

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. Note: To show all line items on the Payment Entry window, enable the Show All Line Items check box. 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. Note: The reason code amount defaults to the Coordination of Benefits Information window if only one

Coordination of Benefits Electronic and Manual Processing

ERA File

Recommendations

Coordination of Benefits Electronic and Manual Processing

Generating Electronic Secondary Claims from Manually Posted Primary Payments

Generating Secondary Electronic Claims

Access the COB Information Window

Enter the Allowed Amount in the COB Information Window

Generating Electronic Secondary Claims from Manually Posted Primary Payments

Coordination of Benefits Electronic and Manual Processing

ERA File

Coordination of Benefits Electronic and Manual Processing

Generating Electronic Secondary Claims from Manually Posted Primary Payments

Generating Secondary Electronic Claims

Access the COB Information Window

Enter the Allowed Amount in the COB Information Window

Generating Electronic Secondary Claims from Manually Posted Primary Payments