Overview
This article will instruct you on how to manually enter COB (Coordination of Benefits) information on a claim, when you want to send to a secondary payer.
Notes:
- An example of when this would be applicable is when a client's primary payer has paid a portion of the service, but there is a patient responsibility that you want to submit to the client's secondary payer.
- Make sure you have the EOB (Explanation of Benefits) or ERA (Electronic Remittance Advice) from the primary payer on hand. You will need to refer to it to fill out the COB tab.
- Procentive is able to automate the process of filling out the COB tab when you are processing a Procentive ERA: Process an ERA to a Secondary Payer.
Enter Information Into the COB Tab
- Access the Change Time window for the date of service you need to submit to a secondary payer.
- Click the COB tab.
- There are two sections in this tab, the CAS Group Code section (top half) and the Amount Qualifier Code section (bottom half).
- The steps below will walk you through how to complete both sections.
- You will need to complete both of these sections based off the information in the EOB or ERA from the primary payer.
CAS Group Code Section
- Prior Payer: Choose the payer that sent the EOB.
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CAS Group Code: From the drop-down menu, select the code(s) that appear on the EOB/ERA.
- Example: The highlighted area below shows the CAS Group on an ERA.
- Example: The highlighted area below shows the CAS Group on an ERA.
- CARC (Claim Adjustment Reason Code): Enter the corresponding code number for the CAS Group Code (eg. 2,45, etc.).
- Amt: Enter the amount for the corresponding CARC.
- Qty: Leave at 0.00
- Click Add.
Important CARC Notes:
- If a payer assigns more than one CARC code for a CAS Group Code (eg: Contractual Obligation 45 and Contractual Obligation 137), these codes must be listed on the same line in the additional CARC, Amt, and Qty fields provided.
- To submit a claim to secondary payer for payment, the CAS Group Code section must include a Patient Responsibility CARC (the most common PR CARC codes are 1, 2, or 3).
Amount Qualifier Code Section
- Prior Payer: Choose the payer that sent the EOB or ERA.
- AMT Qualifier Code: Choose from the list.
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AMT: Enter the corresponding amount for the Amount Qualifier Code.
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Payer amount paid: enter the full amount of payment made by the primary payer.
- You must include this for all claims for all payers.
- If the primary payer paid 0.00, enter 0.00 in the Amount field.
- Allowed amount: shown as code B6 on most remits.
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Payer amount paid: enter the full amount of payment made by the primary payer.
- Click Add.
Verify the COB Tab Balances with the Amounts Tab
- Total the amounts from the CAS Group Code Amt sections and the Payer Amount Paid.
- In this example: 8.28 + 82.25 + 74.47.
- In this example: 8.28 + 82.25 + 74.47.
- Click on the Amounts tab.
- Verify your total equals the Amount (in Rate x Units = Amount).
- In this example: 8.28 + 82.25 + 74.47 = 165.
- In this example: 8.28 + 82.25 + 74.47 = 165.
- Verify your total equals the Amount (in Rate x Units = Amount).
- Click Save.