This article will describe how to submit a secondary insurance claim electronically, with adjudication information from the primary insurance attached.
IMPORTANT NOTE: Before submitting electronic claims to a secondary insurance, check to be sure that the payer accepts secondary claims electronically through the Office Ally clearinghouse, as not all of them do.
For information on how to submit secondary claims via print and mail, please see the following video: Secondary Claims
An increasing number of payers now accept secondary claims via electronic submission. These claims must, however, include information about how the primary insurer processed the claim (AKA: adjudication information from the primary ).
There are two ways a claim can be sent electronically to a secondary payer:
- Manual Electronic Submission.
- Automatic Crossover from the Primary.
In this article, we describe the process for option # 1: Manual electronic submission to a secondary payer.
For more information about how to manage claims that are automatically crossed over to a secondary payer, please see the following video: COB Payment Entry
There are 3 basic steps needed in order to correctly send an electronic claim with adjudication information to a secondary payer:
Properly record payment and adjudication information from the Primary
Send the processed claim back to the Bill Insurance Area
Create and submit the secondary claim electronically
Step 1: Properly record payment and adjudication information from the Primary
Recording adjudication information from a primary insurer starts at one of the insurance payment entry forms. In this step, you will be recording whatever information was sent to you on the EOB from your Primary Insurance.
If utilizing the Batch Insurance Payment Entry Form, select Ins Pmts w/ COB to bring up the Ins Payments w/ Adjudication payment entry form.
If utilizing the Single Session Payment Entry Form, then select Insurance W/ Adjudication Info from the Payment Type drop down menu.
Regardless of which form you use to enter your payment information, there are a few important fields necessary to fill in (see images below):
- The payment information from the primary (i.e. Check Number, Deposit Date, Payment Amount, etc..)
- The payment amount to apply to the service
- The adjustment amount applied to the service, to actually apply the adjustment, be sure to check the “Post” box.
- The remark code given by the payer on the EOB, indicating the reasons for the payment/adjustment. (Remark codes may differ across payers. Therabill uses the standardized CARC codes.
- The patient responsibility remaining (if no adjustment and payment from primary)
- What type of responsibility the patient has (Co-Pay, Deductible, etc..)
If utilizing the Batch Insurance Payment Entry Form:
If utilizing the Single Session Payment Entry Form:
Important - Do not yet hit the Apply Payments or Submit button!
Step 2 : Send the processed claim back to the Bill Insurance area
Once all of the payment and adjudication information has been entered, select the session action of Resubmit (on the batch insurance payment entry form) OR Send to Insurance Invoice Area (on the single Session Payment entry form).
Now click the green Submit or Apply Payments Button
Step 3: Create and Submit the Claim Electronically to a Secondary Insurance
Before moving forward, ensure that the secondary insurance card is saved in the Client’s record. Then, follow the usual steps to submit a claim electronically:
- Go to Billing-->Bill Insurance
- Select the client
- Select the DOS to resubmit
- Click the green Create Invoice button
- Choose the secondary insurance company to submit the claim to
- Click the Lightning Bolt icon to transmit the claim and adjudication information to the payer.
Utilizing ERA for Secondary Claims
If you are receiving EOB information via an ERA within Therabill, then your adjudication information will automatically be attached to secondary claims.
To submit electronically to a secondary just:
- Open the ERA to view the correct DOS and charge
- Select the session action of Send to Insurance Invoice Area and click Apply
- Follow step 3 outlined above to resubmit electronically to the secondary