SYSTOC Setup for COB Claims

Configure SYSTOC to work in tandem with SYSTOC_EDI to manage coordination of benefits (COB).

Navigate to Patient Folder > Patient Summary > Accounts. Both the primary and secondary insurance information must be filled out, along with the relationship to the subscriber. If there is an alternate subscriber, clarify the relationship to the patient.

Navigate to File Maintenance > Setup - Billing > EOMB Codes. To ensure that your EOMB codes are included in SYSTOC_EDI, the ID field must be entered in the following manner: <Group code><Reason code>.
You may find it helpful to include an abbreviated description of both the group and reason codes, separated by a comma in the Description field.

Claim Adjustment Code Examples
ID Description
CO45 Contractual, Exceeds allowable
PR2 Patient responsibility, Coinsurance
PR1 Patient responsibility, Deductible