How do I handle secondary claims?

Question: How do I handle a cross-over claim?

Answer: You would bill the Primary Payer first, then check the primary payer's EOB/ERA and verify that they have not already forwarded the claim to the secondary payer.  

Question: What if I checked the EOB/ERA, and the payer did not forward the claim to the secondary payer?

Answer: If the Primary Payer does not auto-cross over claims for you, once you get paid by the Primary Payer, then you would need to submit a claim to the Secondary Payer.

To submit an electronic Secondary Claim in Claim.MD 

1.  Search for the Primary claim. This should be the claim you would like to submit to a secondary insurance.
2. Enter the correct secondary Payer Name/Payer ID.
   
3.  Change the Primary option on the top of the View/Edit Claim page to Secondary. 
   
   Institutional Claims

   Please note that the same process applies to Institutional (UB-04) Claims. For secondary claims, the dropdown is located further down the form under Payer Name (Box 50).
   
   

1. Fill in any required information displayed in red fields. In this example, you need to complete the following fields: the Insured I.D. Number in box 1a, the Secondary Insured Name, the Secondary Insured's Policy, the Secondary Payer Name, and the Secondary Relationship.
   
   
   ADJUSTMENT REASON CODE

   Note that when Secondary or Tertiary is selected in the dropdown, the Adjustment Reason Code fields will display below line 24. In these fields, enter the adjustment code, the adjustment amount, the Remit Date, and what has already been paid.
   Please also note, that if the primary payer is enrolled for ERA in Claim.MD, it will auto-fill the ERA codes and payments / rejections if there are any ERA received for the primary claim.
2. Click  to submit to the secondary payer.

Check ERA Associated with Claim

To check to see if ERA is associated with a claim, click on the Show History / Notes button on the bottom right corner and search for the EFT/Check#.

Searching for Secondary Claims 

To search for a secondary claim:

1. Click in the Search page in the left navigation menu.
2.  Enter as much detail as needed in the Search fields to find the specific claim or group of claims.

To make it easier to find and differentiate the primary and secondary claim, a "2" will be displayed in the last column next to the secondary claim.

Show History / Notes for Secondary Claims

• If there is a secondary claim, the Show History / Notes for the secondary claim will have a link in the Event column notifying that it is "associated with another claim". Click on the link to bring you to the primary claim associated with it. 
• Similarly, the Primary claim will have a "New Claim Created from this Claim" link in its Show History / Notes. Click on this link to view the Secondary Claim.

Handling Tertiary Claims

Handling tertiary claims is almost exactly the same as creating secondary claims. 

Make sure a secondary claim is already created and search for the claim.

1. Enter the correct tertiary  Payer Name/Payer ID.
   
2. Change the Secondary option on the top of the View/Edit Claim page to Tertiary.
   
3. Fill in any required information displayed in red fields. In this example, you need to complete the following fields: the Insured I.D. Number in box 1a, the Secondary Insured Name, the Secondary Insured's Policy, the Secondary Payer Name, and the Secondary Relationship.
   
   ADJUSTMENT REASON CODE

   Note that when Secondary or Tertiary is selected in the dropdown, the Adjustment Reason Code fields will display below line 24. In these fields, enter the adjustment code, the adjustment amount, the Remit Date, and what has already been paid.
   Please also note, that if the primary payer is enrolled for ERA in Claim.MD, it will auto-fill the ERA codes and payments / rejections if there are any ERA received for the primary claim.
4. Click  to submit to the tertiary payer.