COB Electronic Claim

COB Electronic Claim – Medicare Primary (United Healthcare Requirements)

  • Adjustment Group Code: Submit other payer claim adjustment group code as found on the 835 payment advice or identified on the EOB. Do not enter at claim level any amounts included at line level. Deductible, co-insurance, copayment, contractual obligations and/or non-covered services are common reasons why the other payer paid less than billed.
  • Adjustment Reason Code: Submit other payer claim adjustment reason code as found on the 835 payment advice or identified on the EOB. Do not enter at claim level any amounts included at line level. Deductible, co-insurance, copayment, contractual obligations and/or non-covered services are common reasons why the other payer paid less than billed.
  • Adjustment Amount: Submit other payer adjustment monetary amount.
  • Medicare Paid Amount: Submit other payer claim level and line level paid amount when UnitedHealthcare is secondary to Medicare.
  • Medicare Approved Amount: Submit other payer claim level and line level allowed amount when UnitedHealthcare is secondary to Medicare.
  • Patient Responsibility Amount: Submit monetary amount the member is responsible for as found on the 835 payment advice or as identified on the Medicare EOB.
  • Medicare Acceptance of Assignment: Submit value to indicate whether the provider accepts Medicare assignment.
  • Preference: Submit professional claims at the line level if primary payer provides institutional claims at either line or claim level. The service level and claim level should be balanced. UnitedHealthcare follows 837P/837I guidelines.

To learn more about EDI in Healthcare and become a certified EDI Professional please visit our course schedule page.

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