Author Topic: PIP - How to bill secondary health insurance after Geico payment received.  (Read 2726 times)

2012billingrep

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I have received payment from Geico for a PIP patient. Since they cover 80%, how do I go about billing their secondary health insurance (Aetna) for the remaining 20%? Do I have to create a secondary claim to Aetna and show what was billed and what was paid by Geico and what balance is due? If so, I use OfficeAlly and am not able to change item 30. 'Balance Due'. Also the patient has a $500 deductible with Geico which she is yet to pay. Would I need to take the $500 off the 'balance due' even though she has not yet paid it?

Do I need to attach a letter of explanation and a copy of the EOB from Geico? Or can I simply submit the secondary claim electronically?


PMRNC

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It all depends on if their state is no fault or not.. and if they opted for the rider for MM coverage after PIP.
I would think you should submit a manual secondary claim and attach the primary EOB. since the PIP had deductible of $500, the secondary may or may not pick up depending on their coverage/policy.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

2012billingrep

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Thank you for the reply. We are in Florida. I was trying to do a secondary claim electronically but Geico's EOBS aren't as detailed as some of the other insurance companies so I can't figure out what group codes to use. I will try and do it manually.


PMRNC

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Interestingly enough Florida is in the news with No-fault as they may be doing away with it.. http://www.insurancejournal.com/news/southeast/2013/04/05/287256.htm

They also went through some changes 1/1/2013, this is a great PDF http://www.kirkpinkerton.com/pdf/PIP-COVERAGE-FLORIDA.pdf   
Mainly you will want to make sure all PIP is exhausted before any secondary carrier be billed. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

2012billingrep

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Why is it advised to wait until all PIP is exhausted before billing the secondary insurance? I am afraid that if I wait and it is not exhausted, by the time it is, it might be too late to bill the secondary insurance for the remaining 20%. I am not sure what the timeframe is on secondary claims.

PMRNC

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I've learned many years ago the question "WHY" isn't productive in our business.

The carrier WILL take into account the timely submissions with the first. The hard fact of the matter is that PI, PIP and WC cases DO indeed take longer to collect on. Can't tell you WHY.. only it is what it is. Surely if your primary pays their share and you wait a year to submit to secondary you will have a problem, but the primary and/or PIP carrier is going to send you an explanation of what they are doing... Pending, denying, requesting additional information, etc.   the clock on the secondary isn't going to tick until the final consideration from the PIP is done.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

2012billingrep

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Alternatively, can we just charge the patient the 20% and have them try and recover this from their health insurance company themselves?

PMRNC

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Not necessarily.. You have to follow guidelines of both primary and secondary procedures. Also you might want to take into consideration that no matter what, whether you bill the patient for secondary or not, patient still needs to bill secondary, you have a better shot of timely collection AFTER PIP than they do.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com