About Client Other Healthcare Coverage
The Client Other Healthcare Coverage form captures Other Subscriber Information to be included in outbound 837 claim files. This form is available within myAvatar Cal-PM and ProviderConnect NX.
The Client Other Healthcare Coverage form allows myAvatar to handle scenarios when Third Party Adjudication Data (also referred to as Other Healthcare Coverage or OHC) claims are submitted manually through ProviderConnect NX or myAvatar MSO.
Note: this functionality should only be configured by a Managing Organization that utilizes myAvatar MSO to adjudicate inbound claims from a contracted provider network. The Client Other Healthcare Coverage form should only be used to capture information for individuals receiving services from a contracted provider and will have no impact on how liability distributes within myAvatar. Any primary, secondary, or tertiary payer information that needs to be collected for an individual receiving services directly from a Managing Organization should still utilize Financial Eligibility. The Client Other Healthcare Coverage form has been introduced to myAvatar Cal-PM and ProviderConnect NX as a client-based, episodic form.
The information collected in the Client Other Healthcare Coverage form will generate on a Cal-PM outbound 837 Professional or Institutional file in the following segments:
- 2320*SBR – Other Subscriber Information
- 2320*OI – Other Insurance Coverage Information
- 2330A*NM1 – Other Subscriber Name
- 2330B*NM1 – Other Payer Name
Below is a sample 837 with the OHC / Coordination of Benefits information included. The highlighted segments are generated through the information entered in either the Client Other Healthcare Coverage form and in the Third Party Adjudication Data fields in the Claims Processing and Fast Service Entry forms in myAvatar MSO and ProviderConnect NX.
