Update Coordination of Benefits Settings

The Coordination of Benefits (COB) Update feature allows you to select coordination of benefits language settings used to calculate secondary payor expected reimbursements. This feature contains a list of standard secondary payor calculations that you can apply across multiple contract profiles simultaneously.

The selected calculation method is used to calculate secondary reimbursement for accounts that list any of the selected profiles as a secondary product. The language category assigns a value of favorable or unfavorable to distinguish profiles where the likelihood of collecting is either favorable or unfavorable. If COB is fully enabled for your facility, you can use this classification to filter accounts in the Payor Worklist. If COB reports are enabled for your facility, this field also determines which report displays the secondary reimbursement detail for claims repriced with this contract profile:

  • Secondary Payor Reprice - Favorable Report
  • Secondary Payor Reprice - Unfavorable Report

The results of the calculations are written to one of the following reports, depending on the language category you select for the contract profile. These reports are available on the Batch Report Archive page (Go To > Reports) and include the following:

  • Secondary Payor Reprice - Favorable Report
  • Secondary Payor Reprice - Unfavorable Report
  • Secondary Payor Reprice - Exception Report

Note: This page allows you to update COB settings across multiple contract profiles simultaneously and can be used to define these settings quickly, prior to completely enabling COB for your facility. Once COB is fully enabled, changes to the contract profiles impact reprice calculations and must go through the standard check out and check in process. Once COB is fully enabled this page is no longer available and changes to contract profiles must be made one at a time through the Edit Contract Profile page.

  1. To access the Coordination of Benefits Update page, select Go To > Contract Loading > Support Functions > Coordination of Benefits Update.
  2. Enter search criteria in the Contract Profile Settings section to search for a specific group of contract profiles. You can search by any combination of the following criteria:
    • To search for contract profiles with a specific calculation method already defined, select the check box(es) for the calculation method(s).
    • To search for contract profiles with a specific check out status, such as Checked Out By Me, click the Check Out Status drop-down list and select the desired status.

      • Note: You do not have to check the contract profiles out prior to updating the COB settings from this page. The contract profiles can be in any check out status.

    • To search for contract profiles with a specific effective date, enter a date range in the Effective fields.
    • To search for contract profiles by name, type the profile name in the Contract Name field.
    • To limit the profiles that display to the most recent versions, select the Display only most recent profile(s) check box.
    • Select the sort criteria that determine the order in which the contract profiles display.
  3. Click Refresh View. The contract profiles that match your search criteria display.
    • To clear your search results and reset the page to the default values, click Reset Criteria.
  4. Select the check box for each contract profile you want to update.
    • To select all contract profiles in your results, select the All check box.
    • To clear the check box for all contract profiles in your results, clear the All check box.
  5. Click the Calculation Method drop-down list and select the calculation method to use when this profile is the secondary product.
    • The details of the calculation method are listed in the drop-down list.
    • When you select a calculation method, the actual calculation for that method appears in the Calculation field.
  6. Click the Language Category drop-down list and select Favorable, Unfavorable, or None.
    • The language category determines which report displays the secondary reimbursement detail for claims repriced with this contract profile.
    • To display the COB reimbursement details on the Secondary Payor Reprice - Favorable Report, select Favorable. This report is typically used to show secondary payor reprice information where the likelihood of collecting is high.
    • To display the COB reimbursement details on the Secondary Payor Reprice - Unfavorable Report, select Unfavorable. This report is typically used to show secondary payor reprice information where the likelihood of collecting is low.

      • Note: If you select None in the Language Category drop-down, the COB reimbursement details display on the Secondary Payor Reprice - Unfavorable Report.

  7. Click the Reprice drop-down list and select Yes to have this profile perform COB reprice calculations.
    • Selecting Yes writes the COB reimbursement details to the Favorable or Unfavorable report, depending on the selected language category.
    • Selecting No or None writes the COB reimbursement details to the Exception report.
  8. Click Update. The Coordination of Benefits settings are applied to all selected contract profiles.

The following table describes the fields on the Coordination of Benefits Update page.

Field

Description

Activation Date

Date when the profile is available for processing (repricing)

Active Status

Indicates the purpose and progress of the contract profile you are editing

Calculation

The details of the selected COB calculation method. This field is only populated after you select a calculation method in the Calculation Method drop-down list.

Calculation Method

The COB calculation to be used when this profile is the secondary product. The details of the calculation method are listed in the drop-down list. When you select a calculation method, the actual calculation for that method appears in the Calculation field.

Check Out Status

Used to filter results based on the contract profile check out status

Contract Name

Name of the contract profile

Display only most recent profiles

Select to display only the most recent version of a given contract profile in your results

Effective

Date when the profile is effective

Facility/Location

Facility or group of facilities in which the contract profile was created

Implementation Stage

Current implementation stage of the profile

Implementation Status

Current implementation status of the profile; progression within the current implementation stage

Language Category

Determines which report displays the secondary reimbursement detail for claims repriced with this contract profile:

  • Secondary Payor Reprice - Favorable Report or
  • Secondary Payor Reprice - Unfavorable Report

Reprice

Determines whether the profile performs COB reprice calculations