Yes, you can! There are two ways you can accomplish this. If you are receiving 835's (Electronic Remittance Notices), the COB (Coordination of Benefits) information is automatically linked to your line item when the ERN is processed in CPR+. Issue #57 of the Weekly Infusion provides additional information on this functionality. If you don't receive electronic payment data, you will need to manually enter the COB information from the paper EOB.

Before you begin, make sure your Electronic Medical Payors are set up correctly. Here's how: Open the primary insurance company database, (Databases (7) > Insurance Companies (4)). Make sure your NAIC Payor ID (the number that identifies the primary payor) is populated on the General/Billing Info tab. This should be the same number as the WebMD Medical #.

Let's look at the fields on the Electronic Info tab (of the primary claim) to be sure all the fields marked with an asterisk are populated (Insurance Type Code, Signature Source, Patient Relation, Type of Claim, and Release of Info Code).

From the Account Status Screen, you can either post your primary payor payment and/or drop the claim to second by clicking the Bill 2nd (F6) button. Once you have dropped to second, you can edit the secondary claim as needed. Make sure the required fields are populated on the Electronic Info tab of the secondary claim also. Click the Line Items (F4) button to edit, highlight the line item, and press <Ctrl+F12>. This will open your COB Interface window.

You must select the primary payor in the Insurance Company field and then click the Add (F10) button and populate all the information (Claim Adj. Group and Reason Code, Adjustment Amount, Quantity Adjusted, and Adjustment Date). You will find the Adjustment Group and Reason Code on your EOB. To verify the information balances, use this formula: Charges - Adjustment(s) = Amount Paid. Your Quantity Adjusted is the quantity of the particular line item currently selected. The Adjustment Date is equal to the date of the EOB. This step will need to be completed for each line item.

Once this is complete, press the Save & Close (F2) button on each window, returning to the secondary claim. Some payors still require a claim level COB, although it is rare. If it is required, press <Ctrl+ F12> to open the COB Interface window. Once again, populate the Insurance Company with the primary payor.

Typically, the only field that needs to be populated on the claim level is the Patient Responsibility field on the Adjustment Totals tab, though some Payors may require more information.

Once you press Save & Close, you can be assured that when the claim is transmitted, the secondary payor will receive the EOB information, detailing how the primary payor handled payment/denial of the claim.

Entering EOB Info for NCPDP Secondary Payors

Once the secondary claim is created, it can be accessed from Billing / Financial (5) > Electronic Claims Submission (4) > Claims to Adjudicate (2) > Pharmacy Claims (WebMD/RSI) (2). When you edit the pharmacy claim, select the Prescription Data tab. First enter the (C8) Other Coverage Code, selecting the option that is appropriate for the invoice. Then press <F3> for COB / Other Payor, followed by <F10> (Add Payor), and populate the information (Payor, Coverage Type, Payor ID Qualifier, Payor ID, and Paid Date).

Press <F5> followed by <F10> to add the payment information:

or press <F6> followed by <F10> to add rejection information:

When you save the COB windows and transmit your claim, the secondary payor will receive the EOB information that you attached.

If you have any questions please watch our Secondary Billing and COB’s On Demand Training Session or contact the Training Department to schedule a VOS Training Session.

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