Coordination of Benefits

Coordination of Benefits

When Medicare is the Primary Payer, they will, in some cases, do what is called "Coordination of Benefits". This means that they will directly transmit the claim and EOB information to the Secondary Payer for you.   If you are uncertain if Medicare does Coordination of Benefits with a specific payer, you should verify with Medicare directly.

If Medicare will be doing Coordination of Benefits with the Secondary Payer you are billing, you will set up the Secondary payer as a paper insurance company in the Client Setup by selecting the paper version of the Secondary Payer under Secondary Insurance.

When Medicare does Coordination of Benefits with the Secondary Payer, you do not need to print out the Secondary claim and mail it to the payer yourself.  Simply generating the claim will update your client account to reflect that the Secondary Payer was billed, and allow you to post the payment from the Secondary Payer when it is received. 

To set up your client for Medicare Coordination of Benefits:

1) On the left side menu, click Codes Setup and then Insurance Companies. Add a paper version of the Secondary Payer, even if you have an electronic listing for them. 

2) In the Client Setup, select the appropriate Medicare listing for your client under Primary Insurance and enter the Medicare member information, as needed.

3) In the Client Setup, select the paper insurance company for your client under Secondary Insurance and enter the member information, as needed.

4) You will then create your Client Session(s) and bill Medicare as normal. 

5) When you receive the EOB/ERA from Medicare, you may post it.  Remember, any amount entered under the client responsibility (Co-pay, Deductible, or Co-ins) will be billed to the Secondary Payer and any amount entered under Adjust, Other, or Write-off will be written off and not billed to the Secondary Insurance. 

6) In Invoice Clients and Insurance, you will see the Client Session(s) listed again. Under the Bill To column, you will see "SecIns-Paper".  Confirm that all of the information is correct, select the sessions to bill, then click Generate Invoices and Insurance Forms at the bottom.

You will see a link to print your claim forms.  If you would like a hard copy of the claim, you can print it by clicking on the link, otherwise you can return to the dashboard.