This guide walks through how you can manage patients & troubleshoot claims that have secondary or supplemental insurance coverage - where the client has multiple insurance policies(i.e. primary and secondary insurance).
While the workflow detailed below requires more of a manual touch, Jane has made this easier for you to handle if you submit claims electronically & receive remittances or ERAâs through Jane!
- Generating CMS1500 forms for secondary claim submission
- Posting primary EOBs for visits with dual coverage
- Letâs walk through an example - EOBs
- I am trying to record an EOB for a Secondary Claim, but the numbers donât look right. What can I do?
Generating CMS1500 forms for secondary claim submission
đ Jane now supports electronic (EDI) secondary claim submission! Click here to learn more about this feature. đ
Jane lets clinics submit secondary claims electronically or generate a CMS1500 form for paper submission.
To generate a CMS1500 form for the secondary payer, click the dropdown beside the Pay button when viewing a purchase with dual coverage.
Likewise, when working in the Claim Submission Folders, a CMS1500 will be produced for any selected secondary claims when creating batch CMS1500s. You can learn more about batch CMS1500s here.
Posting primary EOBs for visits with dual coverage
If a patient has dual coverage, then youâll want to consider their secondary policy when recording the EOB (remittance) from the primary.
When recording a primary EOB, youâll be able to tell if the patient has secondary coverage if you see the option(s) to pass a portion of the visit to the Next Payer. In Jane, the âNext Payerâ refers to the patientâs secondary coverage.
If the primary insurer doesnât cover the full amount, or if youâd like to pass down the patient responsibility to the secondary, be sure to choose the âCollect from Next Payerâ option before applying your changes to the primary EOB.
Likewise, for each procedure you bill, you can choose to pass down the difference between the Billed Amount and Allowed Amount as well as the difference between the Allowed Amount and Paid Amount to the Next Payer. Just click the dropdown under the Allowed Amount and/or Paid Amount and select the âCollect from Next Payerâ option as needed! Please note if you choose to adjust these amounts on the primary EOB, the remaining balance of the visit after posting the primary remittance will not be passed to the secondary.
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Letâs walk through an example - EOBs
Letâs say I bill two codes, one for $150 and one for $75.
When I hear back from the primary, this is what they outlined in the remittance:
Code 1 - $150
- Allowed Amount $105
- Paid Amount $80
- Copay $25
- Contractual Adjustment $45 ($150-$105)
Code 2 - $75
- Allowed Amount $68
- Paid Amount $58
- Copay $10
- Contractual Adjustment $7 ($75-$68)
Now letâs say that I want to pass down the reported patient responsibly (Copay in this example) to the patientâs secondary to see if theyâll cover it. To do this, I need to make sure I select the âCollect from Next Payerâ option instead of the âCollect from Patientâ option for both procedure Copays.
Note that you donât need to pass everything the primary insurer doesnât cover to the Next Payer.
In this example, I only want to pass the patient responsibility to the secondary, so I choose to adjust off the differences between the Billed Amounts and the Allowed Amounts when recording the primary EOB. The total amount Iâve chosen to adjust (what we call the âTotal Insurance Adjustmentâ in Jane) will not be passed along to the secondary insurer and instead will be adjusted off after I apply my changes.
Now, letâs say that I have billed the secondary insurer and Iâve received a remittance. When I enter the EOB screen for the secondary, this is what weâll see:
Instead of seeing the full Billed Amounts ($150 and $75 respectively) of these procedures, we just see the amounts that were passed down from the primary payer - which we decided to pass down did when we posted the primary EOB.
Now we can record our secondary EOB as needed and weâre done with this visit!
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I am trying to record an EOB for a Secondary Claim, but the numbers donât look right. What can I do?
If youâre having a little trouble recording an EOB for a secondary, the most likely culprit is the information in the EOB for the primary policy.
If the numbers passed from the previous payer donât look quite right, itâs a good idea to give the primary policy EOB a quick glance. You can view the primary EOB by heading to the appointment or purchase, clicking the dropdown beside the primary policy, and selecting the âEdit EOBâ option.
Double check that youâve passed the right amount down to the Next Payer. If you realize youâve made a mistake, you can simply fix it up and re-apply the changes to the primary EOB.
Pro Tipâď¸: If youâve entered the EOB screen for a secondary claim, and it looks like the screenshot below, you most likely need to edit the primary EOB and make sure you pass down some or all of the remaining balance to the Next Payer (instead of passing it to the patient or adjusting it off).
If youâve received a response from the previous payer via an ERA and you have posted that remittance within Jane, you can refer back to the primarysâ remittance by clicking the same dropdown beside the Primary Policy, and selecting View Claim Response.
If you need to adjust any of the numbers passed along to the secondary, the same steps as above would apply here!
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If you have any questions about managing secondary claims or EOBs, weâre happy to help! Use the Help button from within your Jane account or email us at [email protected]. đ