In the Account Module, click New Claim and verify claim information. When you click OK, two claims will be automatically created:
To manually create a secondary claim, highlight the procedures, then click the New Claim dropdown and select Secondary.This is needed if the secondary plan was added after creating the primary claim.
Primary and Secondary claims look like this in the patient account:
After you receive the primary claim and enter the payment, you will receive one of two popups:
Attachment requirements depend on your clearinghouse. Also see Electronic Attachments.
Write-offs for PPOs are typically done on the primary claim only.
Procedures marked as Do Not Bill to Ins can be changed per insurance estimate.
Double-click on the procedure to view the Claim Procedure. Double-click on the estimate and uncheck Do Not Bill to This Insurance. Estimates will then look like this on the procedure:
When creating the claim, highlight the procedures and click New Claim. You will get a prompt explaining the procedure will be excluded from the insurance marked as NoBill.
If primary insurance is received and not paid as estimated, secondary insurance estimates do not automatically update.
If a patient has both primary and secondary insurance and you want benefit estimates to be more accurate, you must set both up as a PPO Percentage plan type. See PPO Insurance Plan, Option 1.
If both plan types are PPO and the primary is not estimated to pay anything, the writeoff that generates will be based off the secondary allowed amount.
Write-off might show zero if plan has a plan type of Category Percentage, and secondary plan is PPO. To change this, see Family Module Preferences, Calculate secondary insurance PPO write-offs (not recommended, see manual). This should only be checked if you understand COB rules and use PPO Percentage Plan types for all in network insurance plans.