Other Coverage Codes

From QuickSCRIP Wiki
Jump to: navigation, search

The other coverage code is transmitted in field C8-308 of the Claim Information segment. This field holds a single-digit code, which indicates the relationship between the primary and the secondary insurances.

The other coverage code is transmitted in field C8-308, and is necessary for billing secondary insurances and copay cards. This code describes the relationship between the primary insurance and the secondary insurance. It informs the secondary insurance whether or not the primary paid, and how much of the copay is supposed to be covered.

In QuickSCRIP, the user will be prompted to enter an other coverage code prior to transmission on all secondary claims. Additionally, this code can be set on a claim with a /OCx (where x = the code number) in the SIG lines. On occasions where there is no primary coverage (such as with certain copay coupons) you will need to add a /OC3 along with additional codes.

Code List

Field Name Description
0 Not Specified
1 No Known Other Coverage
2 Other Coverage Exists; Payment Collected
3 Other Coverage Exists; This claim not covered
4 Other Coverage Exists; Payment not collected
5 Managed Care Plan Denial
6 Other Coverage Denied; not a participating partner
7 Other Coverage Exists; not in effect on date of service
8 Claim is Billing for Copay
9 Insurance Company Defined Exemption

The most commonly used codes are:

  • 2 - For when the Primary Accepts the claim, pays part of it, and leaves a copay.
  • 3 - For when the Primary doesn't accept the claim (Typically product not covered rejections).
  • 4 - For when the Primary Accepts the claim, but doesn't pay anything
  • 8 - For when the Primary Accepts the claim, and leaves some copay remaining. (This one is very common on coupons and copay reduction cards)

Sending an Other Coverage Code

Putting a \OCx (x = desired code) in the SIG lines will populate this field. Additionally, this code can also trigger the rest of the Coordination of Benefits fields to be sent.

In the New Dual Billing Programs, QuickSCRIP will automatically prompt you for this code if you are sending a claim that has already been paid by another insurance. QuickSCRIP will make the default option change based on how the primary insurance handled the claim. You can also manually change the claim with the # key, prior to transmission.