To submit a secondary claim, please ensure the following requirements are met:
Prerequisites
Primary claim has been processed
The primary insurance (payer) must have fully processed the claim. You should have an Explanation of Benefits (EOB), either electronic or paper, available.-
Secondary insurance information is complete
The patient’s secondary insurance must be added to their profile with all required fields completed, including:Insurance name
Policy number
Relationship to insured
Patient demographics
Payer name and payer ID
Submitting the Secondary Claim
This demo video demonstrates the steps outlined below:
Once the prerequisites above are complete, navigate to the Processed Claim Details screen to submit the secondary claim. You can access this screen in any of the following ways:
From the Checkout screen
Click the paid amount under the Claim column (see screenshot below). This will open the Processed Claim Details screen.
From the Claims Listing page
Go to Shortcuts > Claims (HCFA) under the Billing & Sales section, then click the paid amount under the Claim column.
While posting the primary insurance payment
You may also generate the secondary claim at the time you post payment for the primary insurance.
From the Processed Claim Details screen, ensure all applicable fields are completed, including the amount paid by insurance, any patient responsibility, write-offs, and other relevant amounts (see above screenshot for example).
Be sure to add any necessary adjustment codes by selecting Add Adjustment. For example, when posting a $15.00 copay, enter:
$ Amount: 15.00
Group Code: CO or PR (Patient Responsibility), as applicable
Reason Code: 3 (Copay) or 45 (Contractual Adjustment), as appropriate
Adding a denial reason from the Denial Reason drop-down menu is optional; however, it is highly recommended to support accurate claim tracking and reporting.
Note: If you need to look up reason codes, please use this source: http://www.x12.org/codes/claim-adjustment-reason-codes/
Confirm all entries are accurate before proceeding with the secondary claim submission. To generate the secondary claim, click Generate Secondary Claim from the Processed Claim Details screen.
A pop-up window titled Secondary Claim EDI will appear; select Save and Submit to submit the claim.
We recommend entering the secondary claim submission date in the Notes field on the Processed Claim Details screen. This note will populate in the Comments column on the Claims Listing page. This is recommended because the date shown in the Submit column reflects only the primary claim submission date.
Once complete, click Save rather than Save and Mark Done, as you will need to wait for the secondary claim to process and post payment.
To view details for any secondary claims, click “View Secondary Claim” from the Processed Claim Details screen. The claim status will then be displayed on the Secondary Claim EDI screen. Additionally, you'll see the secondary claim status from the Claims Listing page.