Billing: Secondary Coverage

Understanding how to manage secondary insurance coverage is crucial for ensuring proper billing and reducing the financial burden on patients. This guide will walk you through the steps to add secondary insurance coverage and effectively transfer any remaining patient responsibility to the secondary payer.

How to add: Secondary Coverage


First thing to do is verify on the portal of the secondary coverage they are active on the date of service. Please make sure that save that coverage in the patient folder as "Secondary coverage"


  • Step 1: Verify Secondary Coverage

  1. Log into the Secondary Insurance Portal:
  2. Confirm the patient’s secondary insurance is active for the date of service.

  3. Check for eligibility, member ID, and plan details.

    Save the Verification:

  4. Save a copy of the eligibility verification document or screenshot in the patient’s folder.
  5. Label it as “Secondary Coverage” for easy identification.

  1. Step 2: Open Registration

    1. Navigate to the Registration System:

      • Access the Patient Guarantor and Coverages section.

        Add Coverage:

      • Select “Add Coverage” and input the details of the secondary insurance.

  1. Step 3: Set Relationship Based on Plan Type

    • Medi-Cal Plans:

      • If the secondary insurance is Medi-Cal, set the relationship to “Self”, provided the patient's member ID is being used.

        Commercial Insurance Plans:

      • If the insurance is through a parent or guardian, set the relationship to “Child” to reflect the parent’s responsibility for the policy.

  1. Step 4: Confirm Filing Order

    • Review the Filing Order:

      • Ensure that the primary and secondary coverages are listed in the correct sequence.

        Make Corrections if Needed:

      • Click on the arrows in the registration system to adjust the filing order.

      • The primary coverage should always be processed first, followed by the secondary.

  1. Step 5: Save and Close

    • Double-check the entered information for accuracy.
    • Save changes to the patient’s record to ensure proper claim handling and billing coordination.

  2. This process ensures all necessary steps are completed for accurate claim submission and patient responsibility management.


Transferring Remaining Self-Pay to Secondary Coverage

Follow these steps to transfer the patient’s self-pay responsibility to their secondary insurance:


Step 1: Access the Patient’s Guarantor Account

  1. Locate the Guarantor Account:
    • Open the patient’s record and navigate to their Guarantor Account.
    • Locate the specific claim that needs to be updated.

Step 2: Update Visit Coverages

  1. Click on the Claim:

    • On the right-hand side, locate the "SELF PAY" section.

      Edit Visit Coverages:

    • Click Edit Visit Coverages under the "SELF PAY" section.
    • Click on the green plus sign and then click Accept to add the secondary insurance to this visit.

Step 3: Transfer Responsibility to Secondary Insurance

  1. Right-Click on "Self Pay":
    • Locate the claim listed as Self Pay (highlighted in purple).

    • Right-click on it and select Next Responsibility.

      Choose Secondary Insurance:

    • Select the secondary insurance you want to transfer the responsibility to.
    • Confirm the transfer to ensure the remaining balance is assigned correctly.
    • Refresh the page it will go back to green which mean it on the transfer to insurance

Step 4: Print and Mail the Claim

  1. Print the Updated Claim:

    • Once the amount is transferred, print the claim immediately. By right clicking Demand claim.

      Attach EOB:

    • Ensure the Explanation of Benefits (EOB) from the primary insurance is attached to the printed claim.

      Mail the Claim:

    • Send the printed claim along with the EOB to the secondary insurance provider promptly.

    • This ensures the claim submission adheres to timely filing guidelines.



Updating Account Notes

Ensure thorough documentation for continuity and clarity in the patient’s account:


Step 1: Document Patient Contact

  1. Log the Interaction:
    • In the Account Notes section, document that the parents reached out via phone or email to update the insurance coverage.
    • Include the following details:
      • Date and time of the contact.
      • Method of communication (phone, email, etc.).
      • Key points discussed (e.g., insurance update and verification).

Step 2: Record Claim Submission

  1. Add a Note About the Claim:
    • Clearly state that the claim was mailed to the secondary insurance with the primary insurer's EOB attached.
    • Specify the date the claim was sent.
    • Mention that all necessary supporting documentation was included to avoid processing delays.

Step 3: Provide Context for the Next Biller

  1. State Action Steps:
    • Note that the responsibility has been transferred to the secondary insurance.
    • Include any follow-up actions the next biller might need to take, such as tracking claim status or responding to requests from the secondary insurer.

Sample Account Note:

"On [date], parents contacted us via [phone/email] to update the patient’s secondary insurance coverage. Coverage was verified as active for the date of service. The claim for the remaining balance was mailed to the secondary insurance on [date], with the primary insurer's EOB attached. No further patient responsibility at this time. Next biller may follow up for claim status if required."

Keeping comprehensive and precise account notes ensures smooth handoffs and minimizes errors in billing workflows.



Last updated: 12/27/2024

By: DP