Do you bill for clients that have both a primary and secondary insurance policy?
Check out this guide to learn how easy it is to manage and bill secondary insurance claims through Jane.
🇺🇸 Before you keep reading, note that this workflow only applies to our American clinics that bill insurance. 🇺🇸
- I’m short on time, what are the key takeaways?
- What are the differences between billing primary and secondary claims?
- How are secondary claims managed within my claim submission folders?
- How do I bill secondary insurance claims electronically?
- What if the primary insurer forwards claims to the secondary (i.e. Medicare)?
If you don’t have time right now to read this guide top to bottom, here are the key TL;DR takeaways…
- Secondary claims can only be billed once you’ve received a response from the primary insurer because secondary payers need to know how the primary adjudicated the claim.
- Secondary claims start in the Waiting on Primary folder. Once the primary claim is marked Approved, Jane will automatically move the secondary claim to the Draft or Unsubmitted folder so that you know it’s ready to be billed.
- The electronic claim submission process for secondary claims is pretty much exactly the same as the process for primary claims. The only difference is that secondaries require more information (which Jane will help you fill in if you’re using our ERA feature 😉).
- If you upload ERAs to Jane, then you’ll be able to bill secondary claims as quickly as you bill primaries.
- There’s an insurer setting you can turn on (Settings > Insurers) for payers, like Medicare, that forward claims to secondary payers. This will make sure those claims land in the appropriate folder right away.
- Join our US Billing Community💙🇺🇸 For exclusive access to third-party billers who work with Jane and join a helpful bunch of fellow practitioners, billers, admin staff, and more!
You can also check out this 3-minute video and skip to the parts that are most relevant for you!
What are the differences between billing primary and secondary claims?
There are two main differences between primary and secondary claims.
Difference #1 The timing of when primaries and secondaries can be billed.
Primary claims can be billed immediately after your client’s appointment, while secondary claims can only be billed once the primary payer has adjudicated the claim (once you’ve received a remittance from the primary).
Difference #2 The information that’s required for submission.
Secondary insurers need to know the following information, all of which can be found on the primary payer’s remittance.
- The amount the primary insurer paid towards each CPT code.
- The effective date of the primary’s payment/response for each CPT code (it’s usually the same date for each CPT code).
- Any claim adjustment reasons codes (CARCs) and amounts sent by the primary insurer. These are reasons why the primary payer didn’t pay the full amount of what you billed, which include patient responsiblity.
How are secondary claims managed within my claim submission folders?
Unlike primary claims that start in the Draft or Unsubmitted folder (depending on your billing settings), all secondary claims start in the Waiting on Primary folder.
The great thing about the Waiting on Primary folder is that Jane handles all the work. It’s really just a waiting room for your secondary claims, and Jane will automatically escort them to the Draft or Unsubmitted folder once the associated primary claim moves to the Approved folder.
Marking the primary as Approved tells Jane that you’re done with billing the primary payer, and it’s time to bill the secondary. Note that primary claims are marked as Approved when you apply an EOB where nothing is left outstanding for the primary (you aren’t expecting more money from the primary).
Once a secondary claim has been moved to the Unsubmitted or Draft folder, you know that it’s ready to be billed.
How do I bill secondary insurance claims electronically?
The workflow for billing secondary claims is almost exactly the same as the workflow for billing primaries. For a refresher on how to bill claims electronically, you can quickly pop over to this guide
The only difference is that secondary claims require some additional information before you’re able to generate a submission. Like we mentioned earlier in this guide, this is because the secondary insurer needs to know how the primary adjudicated the claim.
Although secondary claims require more information than primaries, Jane makes it possible to bill secondary claims as quickly as primary claims. 🏎
If you upload ERAs to your account, Jane automagically fills the primary remittance details for your secondary claims. That means when you go to bill a secondary claim in your account, all the required information from the primary payer’s remittance will be filled in for you. 🪄
If you aren’t uploading ERAs to Jane, then you’ll need to manually input the required information from the primary payer’s remittance before billing a secondary claim.
What if the primary insurer forwards claims to the secondary (i.e. Medicare)?
If you bill an insurer that forwards claims to secondary payers, like Medicare, then you can change how secondary claims are managed by enabling an insurer preference. To do this, pop into Settings > Insurers, edit your insurance, and enable the Insurer Submits Claims to Secondary Payers setting.
If you enable this preference for an insurer, then the secondary claims will move through the claim submission folders a bit differently whenever this insurer is the primary payer for one of your clients with two insurance policies. When the primary claim is submitted, then Jane will also mark the secondary claim as submitted. When you submit to a primary payer that forwards claims, you’re essentially submitting to both the primary and secondary insurers in one swoop. That’s why we built this preference!
Let’s explain this further by walking through an example.
Let’s say I enable this preference for my Medicare insurer, and I have a patient — Jamie Harrison — who has Medicare as their primary and some supplemental/secondary coverage with Aetna.
When I arrive Jamie Harrison’s appointment, the secondary claim will still start in the Waiting On Primary folder.
When I submit Jamie’s primary claims, the secondary will be moved from the Waiting On Primary folder to the Submitted folder.
Jane didn’t automatically fill in primary remittance details for my secondary claim. Why?
There are reasons why Jane won’t automatically fill in the primary remittance details for a secondary claim.
You aren’t uploading ERAs to Jane! To learn how to speed up your secondary claims billing as well as your payment posting process, check out this guide.
The primary payer’s claim response doesn’t perfectly match the claim in your Jane account (i.e the CPT codes don’t match).
The primary payer’s claim response should not be used for submission. For example, Reversal of Previous Payment and Processed as Primary, Forward to Next Payer claim responses should never be used to submit secondary claims.
What happens if there are multiple primary claim responses? How does Jane choose which one to autofill?
Jane will use the most recent claim response (the claim response with the most recent effective date).
Whenever a newer claim response is uploaded, Jane will override any existing information and use the new claim response to fill out the primary remittance fields.
Do you have a question about secondary claims that wasn’t answered in this guide? If so, please reach out to our support team at [email protected].