> ## Documentation Index > Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt > Use this file to discover all available pages before exploring further. # Coordination of Benefits & Secondary Claims — Integration Documentation > Spec: PM-30 Status: ✅ Implemented Last Updated: 2026-03-27 Integration Type: Data (same-core PM dependencies) Owner: PM Core **Spec:** [PM-30](../../../specs/pm/specs/PM-30-coordination-of-benefits-secondary-claims.md)\ **Status:** ✅ Implemented\ **Last Updated:** 2026-03-27 **Integration Type:** Data (same-core PM dependencies)\ **Owner:** PM Core *** ## Overview PM-30 adds COB priority order management, secondary/tertiary claim generation from primary ERA adjudication data, Medicare–AHCCCS dual-eligible crossover routing, and secondary ERA posting. All dependencies are within the PM core (same-core data access); no cross-core imports are introduced. *** ## Integration Points ### PM-01 — Patient Registration & Demographics * **Type:** Data (same-core) * **Usage:** Patient identity and insurance policy records. PM-30 reads `pm_insurance_policies` (with new `priority_order` column) and `pm_patients` (with new `dual_eligible` column). PM-30 does not write to PM-01-owned tables except via extension columns added by PM-30's own migration. * **Data Flow:** PM-30 reads → PM-01 data; PM-01 does not consume PM-30 data directly. ### PM-02 — Insurance & Eligibility Verification * **Type:** Data (same-core) / UI trigger * **Usage:** When `cob_order_change_triggers_reverification` is enabled in pm\_module\_settings, changing priority\_order on a policy prompts staff to re-run PM-02 eligibility verification for the affected policy. PM-30 does not call PM-02 directly; it surfaces a prompt that directs staff to the PM-02 eligibility workflow for the policy. * **Data Flow:** PM-30 → user prompt → PM-02 eligibility UI (no direct function call). ### PM-07 — Charge Capture & Fee Schedules * **Type:** Data (same-core, read) * **Usage:** Secondary claim lines reference the same charge items as the primary claim. PM-30 reads charge data from PM-07 tables to populate secondary claim lines; amounts are overridden by primary EOB adjudication data (paid amount, CARC/RARC adjustments, patient responsibility). * **Data Flow:** PM-30 reads pm\_charges → populates pm\_secondary\_claims lines. ### PM-08 — Claims Management & Submission * **Type:** Data (same-core) * **Usage:** Secondary and tertiary claims are rows in `pm_claims` (with `cob_sequence` and `frequency_type_code` indicating secondary/tertiary). PM-30 creates pm\_claims rows for secondary/tertiary claims and links them via pm\_secondary\_claims. PM-08 claim status lifecycle (draft → submitted → paid/denied) applies to secondary claims. PM-08 claim scrubbing (PM-18) applies to secondary claims. * **Data Flow:** PM-30 inserts → pm\_claims (secondary row) + pm\_secondary\_claims (link record). ### PM-09 — Payment Posting & ERA Processing * **Type:** Data (same-core) / trigger * **Usage:** Primary ERA posted by PM-09 is the trigger for secondary claim generation (auto or manual). PM-09 provides primary payment data (paid amount, CARC/RARC adjustments, patient responsibility) used to populate X12 COB2300/COB2400 loops in the secondary 837. Secondary ERA is posted by PM-09 to the secondary claim row; patient responsibility and patient balance are updated accordingly. * **Data Flow:** PM-09 (primary ERA) → trigger → PM-30 secondary claim creation; PM-09 (secondary ERA) → updates pm\_secondary\_claims status + pm\_claims balance. ### PM-15 — Clearinghouse Integration * **Type:** Data (same-core) * **Usage:** Secondary and tertiary 837P/837I claims with COB segments are submitted via PM-15. PM-15 handles 837 batch assembly and submission to the clearinghouse. PM-30 produces the claim record; PM-15 transmits it. * **Data Flow:** PM-30 creates pm\_claims (secondary) → PM-15 batches and submits 837 with COB segments. ### PM-16 — Patient Statement Generation & Billing Communications * **Type:** Data (same-core, downstream) * **Usage:** After secondary/tertiary ERA is posted, updated patient responsibility and patient balance feed PM-16 for patient statement generation. PM-16 reads the updated balance from PM-09/PM-30's posting workflow; PM-30 does not call PM-16 directly. * **Data Flow:** PM-30 (via PM-09 ERA posting) updates patient balance → PM-16 reads updated balance for statements. *** ## Events Published PM-30 does not publish cross-core events at MVP. Secondary claim status changes are internal to PM. Future enhancement: publish `pm_secondary_claim_submitted` and `pm_secondary_claim_adjudicated` events (consumed by PM-11 RCM dashboards and optionally FA for GL write-off). *** ## Events Consumed PM-30 does not formally subscribe to cross-core events. The `cob_secondary_claim_auto_trigger` path responds to PM-09 ERA posting (same-core data; not a cross-core event contract). *** ## API Contracts No cross-core API contracts for PM-30. All integrations are same-core data access. PM-15 clearinghouse API handles external 837 submission. *** ## Platform Integration Layer Usage * **PF-01 (Organizations / Sites):** organization\_id tenant isolation on all PM-30 tables. * **PF-30 (RBAC):** Permission keys `pm.cob.view` and `pm.cob.manage` enforced via `useHasPermission` and RLS. *** ## Pending Contracts | Item | Status | Notes | | -------------------------------------- | ----------- | --------------------------------------------------------- | | `pm_secondary_claim_submitted` event | 📝 Deferred | Future enhancement: PM-11 RCM dashboards; FA GL write-off | | `pm_secondary_claim_adjudicated` event | 📝 Deferred | Future enhancement: same as above | *** ## Security * All pm\_secondary\_claims access is scoped by `organization_id` via `pm_has_org_access` SECURITY DEFINER function. * COB data (payer names, claim amounts, patient IDs) is PHI; no PHI in logs or AI prompts. * UPDATE RLS policy includes `WITH CHECK` to prevent `organization_id` modification. *** ## References * [PM-30 Spec](../../../specs/pm/specs/PM-30-coordination-of-benefits-secondary-claims.md) * [PM-08 Claims Management Integration](./claims-management-submission-integration.md) * [PM-09 Payment Posting & ERA Integration](./payment-posting-era-processing-integration.md) * [PM-15 Clearinghouse Integration](./clearinghouse-integration-integration.md) * [PM-16 Patient Statement Integration](./patient-statement-generation-billing-communications-integration.md) * [CROSS\_CORE\_INTEGRATIONS.md](./CROSS_CORE_INTEGRATIONS.md)