The Insurance Plan listed second in the Family Module (order = 2) is considered secondary insurance.

See our webinar: Secondary Claims

Creating Secondary Claims

In the Account Module, click New Claim and verify claim information. When you click OK, two claims will be automatically created:

• Usually the primary claim will have a status of Waiting to Send.
• The secondary claim will have a status of Hold until Pri received. This claim will stay in the patient's account with the Hold status until sent.

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:

1. If the Account Module Preference for Prompt for secondary claims is checked, you will get a prompt with three options.
   
   
   • Change the claim status to 'Waiting to send': Change the status of the secondary claim to Waiting to Send.
   • Send secondary claim(s) now: Send the secondary claim now.
   • Do Nothing: Do not change the secondary claim.


2. If the Account Module Preference for Prompt for secondary claims is unchecked, you will get a prompt with a list of secondary claims.
   
   Use this information to find and open the secondary claim, verify the claim estimates, and send the secondary claim.

Electronic Claims:

• If sending electronically in 5010 format, the claim information sent to the clearinghouse will include primary claim payment information.
• If sending electronically in 4010 format, the claim information sent to the clearinghouses will not include primary claim payment information.
• If sending in a unique format (other than the 4010 or 5010), check with your clearinghouse.

Attachment requirements depend on your clearinghouse. Also see Electronic Attachments.

• Some clearinghouses require that attachments are uploaded to the clearinghouse first.
• Some clearinghouses only require that claim attachments are marked electronic when sent. They will then notify you when the attachment is needed. See Edit Claim - Attachments Tab.

Set Coordination of Benefits ( COB ) rules in Family Module Preferences.

Write-offs for PPOs are typically done on the primary claim only.

Procedures Marked as Do Not Bill to Insurance

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.

Estimates

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.