Resource Center

Electronic Claims

When to generate a Secondary Claim

To generate a secondary claim the following conditions should satisfy

  • Patient should have a active secondary insurance
  • Primary Claim payments should have Patient Responsibility(PR) or Some procedures were not covered/paid by the primary payer

Generating Secondary Claims

Generate Secondary Claims

  1. To generate a secondary claim, click on the 'Generate Secondary Claim' option in menu against the primary claim. If the primary claim is in 'Not Submitted' status, secondary claim can not be generated.
  2. Clicking on 'Generate Secondary Claim' opens up the claim wizard. This pre- populates all the claim information from the primary claim except the following such as Prior Authorization Number of the primary claim, Original Reference Number used if primary claim is resubmitted. Secondary insurance of the patient is chosen as primary insurance for this secondary claim; primary insurance in the primary claim is chosen as secondary insurance in the secondary claim.
  3. Payment received from primary payer should be put in 'Amount Paid (Copay)(29)' field in Step-2 of Secondary claim wizard.
  4. Navigate through the wizard and verify the details and save the claim.

When Practice is submitting claims using Print Image File(PIF)

  1. Print the secondary claim on CMS 1500 form.
  2. Print the Explanation of Benefits (EOB) document received from the primary payer.
  3. Send claim CMS form along with the primary EOB to the secondary payer either by fax or by mail.

When Claims are submitted electronically (eClaims package enabled practices)

When electronic claim submission is enabled for the practice, secondary claim along with primary EOB information can be sent electronically to the secondary payer. Primary EOB information should be entered in 'Adjudication Details' section, which is final step of the secondary claim wizard. Following sections explain the procedure to add EOB details in the claim wizard. When EOB information is pulled electronically (a feature in eClaims package), adjudication details will automatically be filled.
Add EOB Option

Adding primary EOB Information

  1. Click on 'Add EOB' link in 'Adjudication Details' view. By default all the CPTs in the claim are shown in the Add EOB dialog.
  2. As per EOB, enter the payment, patient responsibility, adjustment for all the CPTs available in the EOB. Some times EOB may not have payment information for all the CPTs available in the claim. In such cases, we receive more than one EOB from payer. When there are two EOBs 'Add EOB' should done twice to add the details in the claim wizard.
  3. Finish adding EOB information in the claim and save the claim.

Examples

Refer the sample EOB shown below. It has two CPTs with a payment $4.30 for CPT 87880 and no payment for another CPT 99211. Next section details how this EOB has to be added to the claim.
EOB Sample

  • Clicking on 'Add EOB' opens the 'EOB Detail View' dialog with all claim CPTs populated by default.
  • For CPT 87880, payment is $25.05. It is entered in 'Paid Amount' field.
  • This CPT has an adjustment of $0.95, which is to be added using 'Add Adjustment' option with Group as 'CO-Contractual Obligation'.
  • Similary the another CPT 99214 has a payment of $113.06. This is entered in the 'Paid Amount' field. It also has a Patient responsibility of $20 and contractual obligation of $28.94.  This is entered in separate adjustment with Group as 'PR-Patient Responsibility' and 'CO-Contractual Obligation' respectively.
  • Update the EOB detail.

Add EOB
EOB information added will be shown in a line item. Refer the below screenshot

Adjudication Detail View
Note: Secondary claims are not listed in the claim reports shown under 'Billing > Reports'.