Author Topic: secondary Ins.  (Read 4211 times)

margemib

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secondary Ins.
« on: February 02, 2009, 11:18:09 AM »
Hi Michele,
I was wondering can you send in secondary claims electronicly?
If so how do you get the EOB to go along with that?
margemib ???
Margie Finlay CMRS

Bev

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Re: secondary Ins.
« Reply #1 on: February 02, 2009, 02:48:22 PM »
I'm in Pennsylvania and the experience that I have with secondaries is that you have to send them in on paper as you need to submit the primary's EOB along with the bill to the 2ndry ins; otherwise, they would not get the 2ndry EOB if you sent the 2ndry claim electronically.  One exception I encountered was with Medicare Region B.  If the patient's 2ndry was set up to "cross electronically", then the 2ndry claim is sent electronically by Medicare along with an electronic version of their EOB to the 2ndry ins.  Sometimes, though, when you have to refile for whatever reason to the 2ndry payer(never received, denied, etc.), you have to send it paper with a paper EOB.  I hope this helps!
« Last Edit: February 02, 2009, 02:51:13 PM by Bev »

Michele

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Re: secondary Ins.
« Reply #2 on: February 02, 2009, 03:05:38 PM »
Secondaries can be sent electronically.  Your Practice Management system will have a way that you enter the info from the primary eob.  Your electronic vendor must set you up for secondary billing, and some of the insurance carriers require testing, but it can be done.  If all the info is entered into the PM system you don't have to attach the eob.

Michele
« Last Edit: February 02, 2009, 03:08:21 PM by Michele »
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Bev

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Re: secondary Ins.
« Reply #3 on: February 02, 2009, 04:18:50 PM »
:DThis is great information to know! (No software I have every worked with has been set up that way.)

Michele

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Re: secondary Ins.
« Reply #4 on: February 02, 2009, 04:23:21 PM »
For us it was our electronic vendor.  We just needed the right script.  It pulls the info from the practice management system and puts it in the right format.  We love it.  No forwarding eobs & claims on paper!  :)

Michele
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Pay_My_Claims

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Re: secondary Ins.
« Reply #5 on: February 02, 2009, 04:47:11 PM »
Misys has that ability with the utilization of the clearing house Payerpath. Our tech didn't have it set up correctly for 2ndary's at first, but once it was done.........ahhhhhhh love

margemib

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Re: secondary Ins.
« Reply #6 on: February 04, 2009, 11:59:52 AM »
Michele,
Also can you tell me what the guidelines are for billing a secondary Ins co for a provider that is a non-par or a par,
after receiving a EOB what charges can you bill for?
margemib
Margie Finlay CMRS

Michele

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Re: secondary Ins.
« Reply #7 on: February 04, 2009, 04:32:10 PM »
You have to bill the secondary the exact same charges that you billed to the primary so that they match the eob.  You print out a CMS form for the same claim that you billed to the primary and attach the primary eob.  It doesn't matter whether the dr is par or not.

Michele
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Bev

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Re: secondary Ins.
« Reply #8 on: February 04, 2009, 04:38:12 PM »
Can you tell me how you know this?  (Trying to convince others is difficult sometimes, so I would like give your source.)  Also, will the secondary accept a "non-par" denial from the primary insurance, ex.  We are non-par with the primary, but we are par with the 2ndry.  Thank you!!

margemib

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Re: secondary Ins.
« Reply #9 on: February 04, 2009, 05:30:43 PM »
Michele,
Do you have to adjust the amount according to the EOB on the secondary claim, someone said if the doctor is a par you cannot charge the secondary for the difference between the amount billed and the amount allowed, only a deductable or co-pay, is this true?
margemib ???
Margie Finlay CMRS

Pay_My_Claims

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Re: secondary Ins.
« Reply #10 on: February 04, 2009, 07:37:03 PM »
I have dropped the balance (entire) to a secondary claim (2 commercial plans) and they have both paid. I have done adjustments to a primary plan, sent the balance to the secondary and it paid more than I billed. The reason....the primary's allowable were lower than theirs. I have NOT seen any rule that states you have to do the adjustments prior to sending to a secondary policy. I think its just an "unwritten" policy. This is why they get the EOB. They want to see what the primary paid, and they pay the difference in what you billed, what they paid, and what they (secondary allows) Medicare has the same policy when they are secondary. If BCBS allowable on a k0005 is 2000, but Cigna's is 2500  and we billed 3000, my provider is losing on revenue because after BCBS paid the 80% of the allowed, I would have to write off 1000 and only bill Cigna for 400. What is a policy is that you can not bill a patient for more than the allowed if you are a contracted provider.

Michele

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Re: secondary Ins.
« Reply #11 on: February 04, 2009, 08:37:38 PM »
I don't really have a source to point you to.  It's just something we have learned over the years.  We have been told, (and have been billing this way for over 15 years) that you need to bill the same fees to both insurances.  You cannot change what you billed (either codes or fees) to the primary when billing the secondary.  Once a claim is created in a practice management system it should be used to print both the primary and the secondary.  Since you are attaching the eob they can see what the primary allowed and paid.  Some secondaries pay only on the balance of the allowed amount, and some use their own fee schedules/allowances to pay. 

Think of it this way, you provided services to a patient and enter the services into the computer.  Then you create a claim for the primary insurance.  When you receive payment and you need to create a claim for the secondary why would you charge anything different than you did for the primary.  Your charges should be the same, just let the insurance carriers process them the way they need to.

Michele


Michele
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Bev

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Re: secondary Ins.
« Reply #12 on: February 04, 2009, 10:26:04 PM »
Will the secondary accept a "non-par" denial from the primary insurance, ex.  We are non-par with the primary, but we are par with the 2ndry.  Sorry if I missed your answer the first time, but I did not see it.  Thank you!!

Michele

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Re: secondary Ins.
« Reply #13 on: February 05, 2009, 07:14:21 AM »
Yes they will.  If you par with the secondary you just need to attach the eob from the non par company that is prime and they will process.

Michele
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Pay_My_Claims

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Re: secondary Ins.
« Reply #14 on: February 05, 2009, 07:54:21 AM »
And not doing the adjustments are not "illegal" you are posting what they paid, letting them know whats due (lines 28 29 30 of hcfa 1500) and attaching the EOB. The EOB keeps you honest. You can't say they only paid 10 when they paid 150. Not doing the adjustments first does not mean I am charging the secondary something different, I am billing the secondary whats left over after the primary paid. Its the insurance companys job to look at the claim the eob and determine by their contract what they can pay, and they can pay up to the max of their allowable. What do you do when one payor doesn't allow for a procedure but the secondary does. Medicare doesn't allow for a power seat, but BCBS does. Medicare denies, and it can drop it to patient responsibility, I place Medicare responsibility as 0, but drop the entire balance to the secondary (if it was no secondary, I can then drop to the patient only because medicare stated it was patient responsibility, otherwise i would have to adjust off).  What I can not do is drop the balance after the insurance pays to the client if I am a par provider, and they don't have a secondary. In those cases, I adjust off the non-allowed and drop only the copays/ded/non covered items to the patient.

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