Billing > Billing
secondary Ins.
Pay_My_Claims:
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:
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
Bev:
--- Quote from: Bev on February 04, 2009, 07:38:12 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!!
--- End quote ---
Michele:
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
Pay_My_Claims:
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.
*Try 1 claim and see what happens.*
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