This document outlines when to generate a Secondary Claim and steps to generate the Secondary Claim.
To generate a Secondary Claim, the following conditions should be satisfied.
When electronic Claim submission is enabled for the Practice, the Secondary Claim with the Primary EOB information can be sent electronically to the Secondary Payer.
The Primary EOB information should be entered in the 'Adjudication Details' section, shown at the bottom of the CMS1500 Form claim wizard. The following sections explain the procedure for adding EOB details in the Claim wizard.
When EOB information is entered manually or pulled electronically (a feature in the e-Claims package), the adjudication details will be filled in automatically.
Refer to the sample EOB shown below. It has two CPTs with a payment of $4.30 for CPT 87880 and $113.06 for CPT 99214, along with adjustments and PR.
The EOB information added will be shown in a line item.
Note: Secondary Claims not listed in the Claim report available under the 'Billing > Reports' section.