| When we first started our medical billing business in | | | | sent through the mail. Whatever the case is, it is |
| 1994 I had no previous experience at billing any | | | | important that you know the order of the policies. |
| medical claims, let alone secondary and tertiary. (You | | | | Once the primary insurance carrier pays their share |
| mean some people have 3 insurances?) I knew | | | | of the claim it is then submitted to the secondary |
| nothing. In fourteen years of billing I've learned quite | | | | insurance company if the patient has one. Secondary |
| a bit and I see from questions in our forum that | | | | claims can also be sent electronically and on paper. |
| many beginners do not understand secondary and | | | | Medicare is mandating electronic submissions even on |
| tertiary claims billing at all. | | | | secondary claims. When submitted electronically all |
| First of all, how does anyone get two or three | | | | the information from the eob (explanation of |
| policies and which is determined primary? If a | | | | benefits) is entered into the claim information and |
| husband and a wife both work (who doesn't?) and | | | | submitted to the secondary insurance carrier. |
| they are both covered by health insurance by their | | | | When the secondary is submitted on paper, the claim |
| employers, they may both have family policies so | | | | is printed out again on a cms form and a photocopy |
| they are both covered under each others plan. One | | | | of the eob is attached. If other patients are listed on |
| would be primary and the other secondary. Now if | | | | the eob, their personal information should be hidden. |
| one of this couple (a few years ago we would have | | | | Many offices use black markers (we call them smelly |
| assumed that it would only be the husband) had | | | | pens) to draw through the unwanted information. I've |
| previous military experience and carried over their | | | | set up a bunch of various width strips of white |
| Tricare military insurance, that would be the third | | | | cardboard that we slide into clear report covers to |
| payor (if there was a balance left). | | | | cover the unwanted information before we |
| Which company is primary and which one is | | | | photocopy. We only do this with companies that are |
| secondary is determined by one of a couple different | | | | not yet accepting electronic submissions. |
| methods. First of all, if a person is working and they | | | | If there is still a balance after the secondary |
| carry insurance, that insurance is primary (unless they | | | | insurance carrier pays their share, the claim is sent on |
| have Medicare and their employer has less than 100 | | | | to the third carrier. It is printed out again on a cms |
| employees). If a person is retired and has Medicare | | | | form and copies of the eobs of both the primary and |
| but the spouse works and carries a family policy, | | | | the secondary insurance carriers are attached. |
| then the spouse's plan would be primary and the | | | | Whenever you send secondary and tertiary claims on |
| Medicare would be secondary. | | | | paper, make sure the photocopies you attach are |
| There is no way to cover every scenario but | | | | clear, easy to read, and for the correct date of |
| basically whether or not the person or the spouse is | | | | service. Many insurance carriers scan the eobs which |
| working can determine the order. For dependents | | | | lightens them a little. If the copy you submitted was |
| (usually children) some go by the "birthday rule" | | | | already light, by the time the claim is processed it |
| meaning that whichever parents birthday falls first in | | | | may be sent back to you as unreadable. It takes a |
| the year is primary. Of course with all of the divorce | | | | lot more time to find the original eob and resubmit a |
| out there sometimes the order of insurance is | | | | claim than it does to get it right the first time. |
| determined by a court order. | | | | Secondary and tertiary claims can sometimes seem |
| When a patient is seen by a provider the claim is | | | | like a pain to get paid - especially because they can |
| sent on a CMS 1500 form to the primary insurance | | | | be for a very small amount of money. It is still |
| carrier either electronically or on paper. Electronically it | | | | important to file and track these claims to keep your |
| can be sent either directly to the insurance carrier by | | | | receivables under control. It may not seem like a lot |
| special software or through a service or through a | | | | of money but it adds up. If you have a system for |
| clearing house. When sent on paper it simple means | | | | submitting them it really isn't that bad. |
| the claim is printed to a paper CMS 1500 form and | | | | |