Submitting secondary claims

To submit claims to the secondary payer, ensure the following are present on a secondary claim before releasing to the payer:

1. Primary Insurance payment (if $0.00 no payment or adjustment is needed)

2. Allowable amount from the primary payment

3. Patient responsibility

4. Adjustments

5. Primary insurance debtor listed

Note:

In order to COB via EDI a claim the primary payment must have transactions that list the patients responsibility, how much the primary insurance allowed and then any payments and adjustments. All these must balance to leave the remaining balance as the patient’s responsibility.