Secondary Billing - Single
This lesson will tell you how to create a single secondary claim.
The majority of secondary claims should be created using our secondary billing batch option. If a secondary claim is not created, the patient will have a balance from the primary claim. After the secondary claim is created, the patient’s balance from the primary claim is transferred to the secondary payer’s insurance balance. This process is known as coordination of benefits (COB).
Note: Do not submit a secondary claim until you have received payment from the primary insurance. Creating a secondary claim before finalizing the primary claim may result in inaccurate AR.
You must meet the following requirements before creating a secondary claim.
- The primary claim must be in finalized status for the COB option to be enabled. This function prefills all primary payment and adjustment information for the secondary payer to review. This information is based on the same information available on the EOB or ERA.
- Each service line must be balanced to $0.00 in the charge ledger.
- If the secondary payer was not on the primary claim, the data must be manually added in the secondary claim form.
There are three types of secondary claims:
Electronic: This is electronically transmitted along with the payment and adjustment information posted from the primary claim. It is not necessary to send a paper copy of the EOB. If an electronic payer does not support an electronic secondary claim, select the Print Locally option.
Paper: Must be printed locally on a CMS-1500 form. We recommended that you attach a copy of the primary EOB to the form.
Crossover: When Medicare is the primary insurance, Medicare will likely crossover the primary claim to the secondary payer. MediTouch does not transmit crossover claims to the payer.
Create a Single Secondary Claim
3. Search – When the patient account number does not match the HF Claim ID use the “Advanced Claim Search” located next to the “Get” button.
Search by Patient Name, Provider, Payer, Service Date, Created Date, or Charges.
Note: Only 1 search criteria is required.
Click claim ID under the payer column.
If the claim is already a secondary claim, there is a COB icon (S) to indicate this next to the FINALIZED status.
Click to highlight the claim and then click Edit.
If this is a new secondary claim, click to highlight the desired finalized claim and then click COB.
The secondary claim screen mimics a CMS-1500 form. If the primary charge was properly balanced, all of the required information will automatically populate and the claim can be submitted without any additional steps. Simply scroll to the bottom and click Submit
If the secondary payer was not on the primary claim, you must manually enter this information.
- Select the Secondary Payer.
- Select a Claim Transmission type – transmit electronically, printing locally, or crossover.
- Select a Payer Address (if necessary).
- Select the Insurance Program (box 1).
- Enter the Insured’s ID Number (box 1a).
- Enter the Insured’s Name (box 4).
Box 24 contains sections for the Service Line and Claim Level Adjustments (electronically known as CAS segments). This section is populated from the numbers in the charge ledger.
- The PR (patient responsibility) amount is populated from the Pat Resp. column.
- The CO (adjustment) amount is populated from the Adjustment column.
- The Payer Paid Amt is populated from the Ins Payment column.
Note: PR – 2 (coinsurance) and CO – 45 (contractual adjustment) are the default group and reason codes used.
Claim-level adjustments are populated from the most recent claim with a Post Claim Level Adjustment transaction.
Primary Payer Pd Amt is a sum of all the service line amounts. The Payer Pd Amt is populated from the most recent primary’s applied payment check date.
