Error Message
You may see one of these messages:
- COB claim failed to balance
- COB claim balancing is failed
Description
This error appears as a rejection in the Electronic Module.
It can appear when:
- COB information entered in the Change Time Window doesn't balance with the amount being billed.
- COB is missing from the claim.
- COB has been entered and the claim is being sent to the primary payer.
Resolutions
- Go to the Electronic Module.
- Click on the Invoice Window.
- Double-click on a service line to open the Change Time Window.
- .In Payer: verify the payer selected is accurate
- This selection should be the same payer listed on the invoice being submitted.
- If you are sending this claim to a primary payer, you cannot have data on the COB tab.
- Check the COB tab for data.
- If data is entered, remove all info listed.
- Resend the claim.
- Check the COB tab for data.
- If you are forwarding the a claim to a non-primary insurance, continue with the steps listed below.
- Click on the COB 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 = 165.
- Click on the Amounts tab.
- Verify your total from above equals the Amount to the right of Rate x Units.
- In this example: 165.
- In this example: 165.
- Verify your total from above equals the Amount to the right of Rate x Units.
- Click on the Billing and Payment tab.
- Click the link provided to the right of Payments.
- This link will take you to the Payments module for this client and Date of Service (DOS).
- Verify the transactions listed on the COB tab have been posted for the same amounts.
- In this example:
- Payment for 74.47
- Adjustment for 82.25
- Secondary for 8.28
- Secondary is the patient's responsibility (PR), or CARC 2, that you are forwarding to the secondary payer.
- Secondary is the patient's responsibility (PR), or CARC 2, that you are forwarding to the secondary payer.
- In this example:
- Once these areas are in agreement resend the claim.
What to Do If Credits Were Also Applied to the Service Bill Line
If any portion of payment was posted using Credits or Takeback Credits you must also complete the Amount for SVD Segment in the Extra Info tab of the Change Time Window. The Amount for SVD segment field needs to reflect the TOTAL payment when a takeback credit or credit is applied: Payer payment + takeback credit/credit = Total amount for the SVD segment field.
Other key settings that may affect secondary claim submission:
- Payers Module > Payer Rules Tab: Submit secondary insurance info must be set to Yes.
- Payers Module > Claim Rules Tab: If there is a setting None in box 11, then set this to No.
- This setting applies to a paper HCFA and would complete box 11 on the HCFA with "NONE" indicating the client does not have a group number
- This setting applies to a paper HCFA and would complete box 11 on the HCFA with "NONE" indicating the client does not have a group number
- Clients Module > Payers Tab > Enrollment sub-tab: For the secondary payer, you must have the field Submit other payer info set to Yes or Default (if payer is set up to submit secondary insurance info).
- Clients Module > Payers Tab > Enrollment sub-tab: The order of payers listed must reflect the primary and secondary payers that were in affect at the time of the DOS.
- Invoice window: Checkbox at the top Do not send other payer info must be unchecked.