Billing Secondary Payers Electronically

Billing Secondary Payers Electronically

Insurance Setup:

If you are billing the insurance payers electronically, you should set up both primary and secondary payers in Insurance Companies under Codes Setup.  
Client Setup:

Client Information

Complete the Client Setup as you normally would for the client including their name, address, contact info, DOB and select the Client Invoice Option.

Primary Insurance:

  • Choose the appropriate payer from the short list.  You may bill the Primary Insurance Payer as an electronic or paper insurance payer.  
  • Enter the ID number and complete the Whose Insurance is This with the Subscriber information.
  • Enter the DOB, Gender, and Client's Relationship.

Secondary Insurance:  
  • Choose the appropriate electronic company from the payer list if electronically billing.  If you are billing as paper, remember that you will need to print the claim and include a copy of the primary insurance payer EOB with the claim.
  • If Medicare is the secondary payer, you must select an Insurance Type.  You may ignore this drop-down box for all other payers.
  • Enter any ID number, Subscriber information and Client’s Relationship.
  • Click Save when completed.

Billing Primary Insurance

1)  Enter the Client Session and Save.

2) Generate the claim to Primary Insurance.  There must be a check in the box and then click on Generate Invoices and Insurance Forms button.

Posting Primary Insurance EOB/ERA 

If you are manually posting the Insurance EOB through Payments Received and Adjustments, then proceed to enter it as the EOB indicates.  This includes entering any client co pay, deductible or co insurance as indicated by the payer.

If you receive ERAs, you may post the Primary Insurance ERA through the auto-posting feature.
Once you have posted the Primary Insurance EOB/ERA, the system will prompt you to Invoice the Secondary Insurance payer in the Invoice Clients and Insurance link (Review Billable Sessions). 

Billing Secondary Electronically

When you go back to Daily Activity and then Invoice Clients and Insurance after posting the Primary Insurance EOB or ERA, you will see that you have another session to bill.  

The session will have a red stop sign next to it.  You must click on the BLUE “EOB” button to view the Primary Insurance payment information that you entered and to confirm the check date.

  • When you click on the EOB button, you will see the Primary Insurance payment information pop up.  Please verify that the payment information matches the EOB/ERA.  This information will be transmitted with the Secondary Claim to the payer when submitting secondary claims electronically (if you are submitting secondary claims on paper, you must still include a copy of the Primary Insurance EOB with the claim).
  • If an adjustment needs to be edited, you will need to Remove and add the new Adjustment Group, Reason Code and Amount.  You cannot edit an existing amount.
  • Click Save once you have reviewed/edited the Primary Insurance EOB/ERA information.  The Secondary Claim should now have a green icon and a check in the box and be billable.

After you’ve confirmed that the EOB/ERA information is correct, you can generate the Secondary claim. NOTE:  You can only invoice one Secondary Electronic Claim at a time.

Posting Secondary Payer Payments

When you are posting the Secondary Insurance Payer payment, whether it is a paper EOB or an ERA, you must enter it via Payments Received and Adjustments.  You may not auto-post secondary ERAs.

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