Simplifying the Process of Billing Secondary Insurance Claims

Home Healthcare Simplifying the Process of Billing Secondary Insurance Claims

When a patient has multiple insurance policies, the complexities to access necessary medical services are increased. To simplify the process, intervention of medical billing companies is necessary in order to communicate effectively among healthcare providers, patients, and insurance companies to address any inquiry or claim disputes, if any.

What is secondary billing?

A patient may have a secondary insurance plan in addition to their primary insurance plan, which is exactly what it sounds like. The claims of primary insurance are paid first when a provider submits the claim for a patient’s treatment or service. Billing Secondary insurance claims pays a portion of the claim after the original payer has paid its share of the primary insurance plan.

The second plan may occasionally come from a parent or spouse who already has an insurance plan. It requires proper usage of the best medical billing software.

Healthcare Professional vs Healthcare Provider for a Billing Company

How do you bill a secondary claim?

Here’s how to submit a claim to secondary insurance if your patient has the coverage through multiple insurance providers:

For each of the insurance plans, confirm insurance and eligibility. Contact the patient and let them know they must amend the COB with their insurer if no plan appears during this procedure as a main insurance plan. The patient must contact the secondary insurance to inform them that they are now the primary insurer, for instance, if the primary insurance has expired but the billing secondary insurance claims are still in effect.

Ask the patient to confirm the COB or get in touch with the insurers if you’re unsure which insurance plan is primary.

When you’re ready to file a claim for the patient’s visits or services, send it to their main insurance provider.

Make a note of the authorised amount, the patient obligation, and any revisions after the primary insurance has processed the claim.

Send the claim to supplemental insurance. Include the initial claim amount, the primary insurance’s payment amount, and any explanations for why they did not cover the total claim. It’s critical to include the remittance details and explanation of benefits (EOB) to prevent the secondary insurance from rejecting your claim. Tell the patient to call the insurers and find out which billing insurance policies are current and primary if there is a COB issue that needs to be resolved.

Send any outstanding balance to the patient after the billing secondary insurance has paid its portion of the claim.

Which Insurance Is Secondary, and How Do I Know?

It’s not always easy to tell which insurance is primary and which is secondary. The patient’s age and insurance status are important considerations. The size of the business offering the employee insurance plan may also affect it.

In most cases, a patient’s primary insurance is their employer’s plan if they have insurance via their place of employment. Medicaid is often nearly the patient’s secondary insurance if that is one of their plans. However, there can be exceptions, so if in question, ask the patient to confirm the COB or contact the insurance providers to confirm.

One of the most important things for healthcare provider solutions to consider when dealing with secondary insurance claims is to ensure they have the proper documentation and coding in place to accurately bill the second insurance provider. This can be achieved by utilising healthcare provider solutions that provide RCM services, which helps streamline the billing process and reduce errors.edures for each claim. It requires a deep understanding of Medical Billing and Coding.

When Can Secondary Insurance Claims Be Billed?

Once you’ve invoiced the first insurer and gotten paid, you can submit a claim to secondary insurance (remittance). The billing of secondary insurance claims electronically, It’s crucial to keep in mind that you cannot bill primary and secondary insurance at the same time.

Insurance companies have stringent guidelines on what they will and will not cover, just like many other parts of insurance billing and coding. Additionally, they have measures in place to make sure that neither of the plans covers the full cost of the bill.

In light of this, the secondary insurance provider will require information regarding the total amount of the bill, the initial insurance provider’s payment, and the reason(s) for not covering the remaining balance. A balance report must provide the adjustments and classifications for the remaining balance.

Secondary insurance claims can be a complicated process for healthcare providers, particularly those offering Urgent Care Billing services

It’s important to note that the process for billing secondary insurance claims may differ depending on the insurance provider and the type of coverage they offer. Some providers may require specific documentation or billing codes that differ from those used by other insurance providers. As such, healthcare providers should work closely with their billing team or outsourced billing service to ensure they are following the correct procedures for each claim. It requires a deep understanding of Medical Billing and Coding.

What Sets Primary Insurance Different from Secondary Insurance?

Primary insurance covers the claim initially, which is the key distinction between primary and secondary insurance. The secondary insurance covers all or a portion of the outstanding debt, which frequently includes a copay.

It’s crucial to understand that just because a patient has two insurance policies, they are not responsible for making any payments. For instance, the deductible of the primary insurance will not be covered by the secondary insurance. Even after both insurance companies have paid their respective portions of the claim, patients may still be responsible for copayments or coinsurance.

Overall, effective management of secondary insurance claims requires a strong understanding of medical billing and coding, the use of reliable healthcare provider solutions, and the use of the best medical billing software available to ensure accurate and timely billing. By taking a proactive approach to billing and working closely with a qualified billing team, healthcare providers can ensure they are maximising their revenue while providing high-quality care to their patients.


Q. How to bill secondary insurance claims?

To bill secondary insurance claims, healthcare providers must first bill the primary insurance provider. Once the primary insurance provider has processed the claim, the healthcare provider can then submit a claim to the secondary insurance provider for any remaining balance.

Q. Who bills secondary insurance?

Typically, healthcare providers or their billing team will bill secondary insurance. However, in some cases, the patient may be responsible for submitting the claim to their secondary insurance provider.

Q. How is secondary insurance billed?

To bill secondary insurance, healthcare providers must first ensure they have accurate documentation and coding in place for the services provided. They should then submit a claim to the secondary insurance provider along with any required documentation, such as an explanation of benefits (EOB) from the primary insurance provider.

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