Can Charges be changed on a secondary claim to honor contract with carrier

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Author Topic: Secondary Claims  (Read 1421 times)


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Secondary Claims
« on: April 30, 2011, 09:59:16 PM »
Primary insurance is Auto(Facility not contracted) Claim was billed @ 100% of charges with no adjustments.  The Auto Insurance exhausted and claim must go to secondary insurance in which facility is contracted with.  Per the contract with the secondary insurance, the implants used must be billed at cost plus a 5% markup which is less than what we billed the primary.  How do we bill the secondary per contract if we billed the primary charges as we would a non-contracted carrier.   Can the charges be changed on the secondary claim to abide by our contract even though the charges were higher on the primary claim?  If the charges are not changed the secondary carrier will consider charges much higher than we are actually entitled to per our contract. Very confused


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Re: Secondary Claims
« Reply #1 on: May 02, 2011, 10:30:30 AM »
You would bill the secondary exactly the same as the primary, with a copy of the e.o.b. from the primary.  You will be paid according to your contract with the secondary and will have to write off the amount not allowed.  Any co-pay or deductible is still due from the patient.  They can most likely get that reimbursed when they settle their auto claim.