About COB Billing

PDX Third Party Exceptions

About COB Billing

EPS uses three types of billing during Coordination of Benefits processing:

With this method, EPS sends an Other Coverage Code of 2 (Payment Collected) or 4 (Payment Not Collected) in the Claim Segment. The system also sends the Other Payer Amount Paid with applicable qualifiers in the COB Segment.

With this method, EPS sends an Other Coverage Code of 8 (Claim is For Copay) in the Claim Segment. The system also sends the Other Payer Patient Responsibility Amount with applicable qualifier(s) in the COB Segment (this is new for NCPDP D.0).

With this method, EPS sends Other Coverage Code of 2 (Payment Collected) or 4 (Payment Not Collected) in the Claim Segment. This method combines the previous two methods by sending both the Other Payer Amount Paid with applicable qualifier(s) AND Other Payer Patient Responsibility Amount with applicable qualifier(s) in the COB Segment. (Sending the Other Payer Patient Responsibility Amount and qualifiers is new for NCPDP D.0).