Orlando Harmon
Posting secondary insurance payments is a process that involves managing payments from multiple insurance plans. It is important to understand the difference between primary and secondary insurance. Primary insurance pays towards the claim first, while secondary insurance covers the remaining balance, which may include a copay. Patients with multiple insurance plans may require billings to be submitted to secondary insurance after receiving payment from the primary insurer. This process requires careful coordination of benefits (COB) to avoid claim denials and payment delays. Electronic systems such as SimplePractice and Jane App offer features to facilitate the management of secondary insurance claims and payments.
| Characteristics | Values |
|---|---|
| Primary insurance | Pays towards the claim first |
| Secondary insurance | Pays some or all of the remaining balance, which can include a copay |
| Submitting a claim to secondary insurance | Submit a claim to the secondary insurance company before billing the patient |
| Submitting a claim to primary and secondary insurance | Cannot submit a claim to both insurance companies at the same time |
| Submitting a claim to secondary insurance | Must include every detail from the primary insurer, including remittance and EOB |
| Submitting a claim to secondary insurance | Must include the total that was billed initially, how much the primary insurer paid, and why the primary insurer didn't pay the full balance |
| Submitting a claim to secondary insurance | Must include specific information on secondary claims to determine how a primary claim was processed |
| Submitting a claim to secondary insurance | Must have the remittance information for the primary claim prior to filing secondary claims |
| Submitting a claim to secondary insurance | Must enter payment information and adjustments based on how the primary claim was processed |
| Charges queued to a subsequent insurance | PCC EHR automatically pends remaining balances to a patient’s secondary coverage |
| Copay amounts changed | PCC EHR can automatically adjust the expected copay for the charge |
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What You'll Learn
Understanding the difference between primary and secondary insurance
Most individuals have a primary insurance plan, but not everyone has a secondary insurance plan. Primary insurance is the main health insurance policy that an individual relies on for medical expenses. It is indispensable and forms the backbone of your healthcare coverage, ensuring you have access to necessary medical services. It is typically the first line of defence in covering healthcare costs and is billed first when you receive healthcare. For example, health insurance provided by an employer is usually the primary insurance.
Secondary insurance is an additional insurance plan that a person may have on top of their primary insurance plan. It is not always necessary, but it can be beneficial for those who qualify. It works in tandem with primary insurance to enhance coverage and reduce out-of-pocket expenses. It typically covers the remaining expenses after the primary insurance payout, acting as supplementary coverage to fill gaps. For example, if you have insurance through your employer and also enrol in your spouse's insurance plan, your spouse's insurance would be your secondary insurance.
It is important to note that having two insurance plans does not mean that you will receive full coverage from both. Instead, one policy will be designated as the primary plan, and the other will be secondary health coverage. This is determined by coordination of benefits (COB), which decides which insurance pays for a claim first. The primary insurance will pay towards the claim first, and the secondary insurance will pay some or all of the remaining balance, which can include a copay.
Some common scenarios in which individuals might benefit from having dual coverage include married couples with separate health plans, children with coverage under each parent, and individuals under 26 who have a health plan through an employer and are also covered by their parents' plan.
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How to submit a claim to secondary insurance
Having two insurance plans can be beneficial, but it's important to understand the difference between primary and secondary insurance. The primary insurance pays towards the claim first, and the secondary insurance pays some or all of the remaining balance, including a copay. It's worth noting that having two insurance plans doesn't relieve the patient of all financial responsibility. For instance, the secondary insurance won't cover the deductible from the primary insurance.
Now, when it comes to submitting a claim to secondary insurance, there are a few steps to follow. Firstly, you need to wait until you've billed the primary insurance and received payment (remittance). It's important not to bill both insurances simultaneously. Once you've received the payment from the primary insurer, collect up-to-date and accurate demographic information about the patient, including their name.
After that, submit a coordination request if both the primary and secondary coverage are under the same insurance company and the insurer supports coordination of benefits. When you do this, only the primary claim is processed in real-time, while the secondary claim is processed manually. If the patient is a child covered under both parents' policies, the claim should be submitted under the policy of the parent whose birthday is earliest in the year.
When submitting the claim to the secondary insurer, include every detail from the primary insurer, such as remittance and EOB. The secondary insurer will need to see the bill total, the amount paid by the primary insurer, and why they didn't pay the full balance. Including adjustments and categories for the remaining balance is crucial for a smooth process.
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Managing multiple insurance plans
Understand the Difference Between Primary and Secondary Insurance
The first step is to understand the difference between primary and secondary insurance. Primary insurance is typically the policyholder's main insurance plan, usually an employer-sponsored or individual plan. It is the insurance that pays towards the claim first, up to its full coverage limits. Secondary insurance, on the other hand, is an additional plan that covers some or all of the remaining balance after the primary insurance has paid its share. It's important to note that having two insurance plans doesn't mean the policyholder has zero payment responsibility. The secondary insurance won't cover the primary insurance's deductible, and the policyholder may still be responsible for copays or coinsurance.
Coordinate Benefits
When managing multiple insurance plans, it's crucial to understand how your plans work together through a process called "coordination of benefits" (COB). This process determines which insurance plan is primary and which is secondary. Contact your insurance companies to understand when and how each plan will cover your costs.
Avoid Common Mistakes
Be aware of common mistakes when dealing with multiple insurance plans. One such mistake is double billing, where healthcare providers bill both insurance plans for the same service, leading to overbilling and confusion. Always review the Explanation of Benefits (EOB) from each plan and clarify any discrepancies with your providers. Don't assume that dual coverage is always the best option; evaluate the costs, coverage, and your specific healthcare needs to determine if it is cost-effective for your situation.
Stay Organized and Seek Expert Advice
Staying organized is essential when managing multiple insurance plans. Keep detailed records of each plan's coverage, benefits, and limitations. Compare plan costs and benefits to find the most suitable options for your needs. Consider seeking advice from a licensed insurance broker or a licensed insurance agent, who can help you navigate the complexities of multiple plans and ensure you're getting the most out of your coverage.
By following these guidelines and staying proactive in understanding your coverage, you can effectively manage multiple insurance plans and maximize the benefits of your coverage.
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Viewing and submitting secondary claims
Submitting a claim to secondary insurance requires attention to detail, knowledge of insurance policies, and adherence to strict billing guidelines. It is important to remember that you cannot bill both primary and secondary insurance simultaneously. The primary insurance pays towards the claim first, and the secondary insurance pays some or all of the remaining balance.
To view and submit secondary claims, follow these steps:
- Verify the patient's coverage: Before submitting a secondary insurance claim, confirm the patient's coverage with both their primary and secondary insurance carriers. This involves checking eligibility, coverage details, and any coordination of benefits (COB) requirements.
- Submit the primary claim first: Send a claim to the primary insurance carrier. Once the primary claim is processed and any applicable payments or denials are received, you can proceed with billing the secondary insurance.
- Collect patient information: Gather up-to-date and accurate demographic information about the patient, including their name, date of birth, and policy details.
- Prepare the required documentation: Typically, you will need to complete a UB04 form (or its electronic equivalent) to provide details of the services rendered, diagnosis and procedure codes, and any payments received from the primary insurance. Attach a copy of the Explanation of Benefits (EOB) from the primary insurance carrier, which outlines their payment or denial decision.
- Submit the secondary claim: Once all the required documentation is prepared, submit the secondary insurance claim to the appropriate carrier, following their specific submission guidelines and deadlines.
- Enroll for electronic payment reports: If you're enrolled to receive electronic payment reports from the primary payer, secondary claims will automatically populate the required information from the primary claims. This simplifies the process and reduces the risk of errors.
- Review and update policies: After entering payments and adjustments, review the amount of the charge that the payer adjudicated as "covered" in the Covered Amount column. Compare this with your practice's Negotiated Rate, if applicable.
By following these steps and paying close attention to detail, you can effectively view and submit secondary insurance claims, ensuring a smooth and efficient billing process.
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Including all required information
When it comes to posting secondary insurance payments, there are a few key steps and considerations to keep in mind to ensure that all required information is included and that the process runs smoothly. Firstly, it's important to understand the difference between primary and secondary insurance. Primary insurance is the patient's main insurance coverage, and it pays towards the claim first. Secondary insurance is an additional insurance plan that a patient may have, which pays some or all of the remaining balance after the primary insurance has paid. It's worth noting that having two insurance plans doesn't relieve the patient of all payment responsibility, and there may still be copays or coinsurance amounts for which the patient is responsible.
When submitting a claim to secondary insurance, it's crucial to follow the correct sequence. You must first submit the claim to the primary insurance and receive payment before approaching the secondary insurer. This is because the secondary insurance company will need to know the total bill amount, how much the primary insurance paid, and why they didn't cover the entire balance. Submitting the claim to both insurance companies simultaneously is not an option. To streamline the process, it's recommended to use a reliable RCM platform, such as Gentem, which offers AI-powered automated claim edits for faster and more accurate claims submission.
In terms of the specific information required for secondary insurance payments, it's essential to include every detail from the primary insurer, such as remittance and the Explanation of Benefits (EOB). This information can often be accessed through Payment Reports, which outline the adjudication details for the primary claim. Additionally, the secondary claim should include the total amount billed initially, the amount paid by the primary insurer, and an explanation of why they didn't cover the full balance. This information is crucial for a seamless secondary claim process.
When dealing with multiple insurance plans, it's important to be aware of the patient's specific policies. For example, if a patient has both Medicare and employer coverage, the paying order depends on the company's size. If there are more than two insurance plans involved, the process becomes more intricate, and it's advisable to seek guidance from a specialised platform, such as Ensora Clearinghouse, which offers unlimited support for complex secondary insurance situations.
Lastly, when posting insurer payments, it's worth noting that they can be posted electronically or manually, depending on how the insurer remittances are received. If the insurer sends electronic remittances (ERAs), it's more efficient to post payments electronically. However, if the insurer only provides paper remittances, the manual posting process through the Billing > Insurer Invoices > New Payment path is necessary.
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Frequently asked questions
Primary insurance pays towards the claim first, and secondary insurance pays some or all of the remaining balance.
No, you cannot bill both at the same time. You need to submit the claim to the primary insurance first, then submit to the secondary insurance.
You will need to include every detail from the primary insurer, including the total that was billed initially, how much the primary insurer paid, and why they didn't pay the full balance.
If you receive electronic remittances (ERAs), you can post payments in the Remittances tab. If you use SimplePractice, you can submit secondary insurance claims electronically, and the required information will automatically populate from the primary claims.
Claims submitted in the wrong order are more likely to be denied. Payers can have unique secondary claim filing guidelines, so it's important to check these.
