Secondary Insurance

This article overviews

  • How secondary insurance works in TherapyNotes 
  • How to add a secondary payer 
  • How to attach a secondary payer to a patient 
  • How to manually update a secondary payer in a billing line item 
  • How to remove a secondary payer from a billing line item 
  • How to create a CMS-1500 for secondary insurance 
  • How secondary insurance works in the insurance aging report

How Secondary Insurance Works in TherapyNotes

  1. The practice submits an electronic claim (EDI) that contains information for both primary and secondary insurance.
  2. The electronic claim contains: 
    • Information about the secondary insurance company (payer name, paper claims address, insured's ID). 
    • Instructions in the claim file for the primary payer to forward the necessary information to the secondary payer electronically. 
  3. The primary insurance sends an explanation of benefits (EOB) or electronic remittance advice (ERA) to the practice. 
  4. The primary insurance pays the practice a portion of the insurance balance owed. 
    • In-Network payers pay the contracted rate. 
    • Out-of-Network payers pay what they decide. 
  5. The primary insurance forwards the EOB / ERA and claim itself to the secondary electronically. 
  6. Secondary insurance sends an EOB / ERA to the practice. 
  7. Secondary insurance pays the practice. 

Although TherapyNotes always includes instructions in the electronic claim for the primary to forward the information on to the secondary electronically, they do not always comply. If you have received payment from the primary and have not yet heard from secondary within a week or so you have two options. 

  • Option 1: Call the primary’s EDI department and ask them why they haven’t sent off the information to the secondary even though TherapyNotes states to do so in the 5010 EDI claim file. 
  • Option 2: Use TherapyNotes to generate a CMS-1500 for secondary insurance, print and mail the paper CMS-1500 and a copy of the EOB from the primary to the secondary as per the instructions that appear later in this article. 

How to Add a Secondary Payer 

First, make sure the insurance provider is listed in your account's Payers list by clicking PAYERS at the top of the screen. If the payer is listed, skip to the next section.

If not, click "+ Add a Payer" and fill out the "Payer Information" tab pictured below. 

  Ins. Provider Name: Type the insurance company in this field, then select an option from the list.

  Insurance Type: Either leave the autofilled option or select another option from the dropdown.

  In-Network: If you are in-network, check the box. If you are out-of-network, leave the box unchecked. 

  Billing Method: Either leave the selection as Default or select another option from the dropdown.

  Payer ID: This field autofills from the selection you added.

Note: This must be the payer ID our clearinghouse uses to route electronic claims to the payer. The payer ID is unique to the clearinghouse, Change Healthcare, and is typically not listed on the insurance card. 

  Address: If you intend to send paper claims (CMS-1500 forms) to this payer enter the payer's paper claims address here.

  • Note: Some payers, such as Magellan, require a PO Box to route electronic claims.

Phone Number: If desired enter the payer's phone number.

Fax Number: If desired enter the payer's fax number.

  Comments: Type any additional comments in this field. 

  Save: Click the green "Save New Payer" button.


How to Attach a Secondary Payer to a Patient

Next, add the secondary payer in the patient's chart under the "Billing Settings" tab. 

  • Click PATIENTS > Click patient > "Billing Settings" tab 
  • Check the box next to "Secondary Insurance"
  • Change the "Payer" dropdown in the Secondary Insurance section. 
  • Click the green "Save Billing and Insurance Settings" button. 

How to Manually Update the Secondary Payer in a Billing Item 

To update billing line items that have already been submitted to insurance: 

  • Click PATIENTS > Click patient > "Patient Billing" tab 
  • Click on date of service. 
  • Click "Update" in line with the primary or secondary payer. 
  • Click "Update Insurance Payer"


How to Remove a Secondary Payer from a Billing Item 

To remove a secondary payer from a billing item: 

  1. Click PATIENTS > Click patient > "Billing Settings" tab
  2. Uncheck Secondary Insurance.
  3. Click the green "Save Billing and Insurance Settings"
  4. Click the "Patient Billing" tab. 
  5. Click on the date of service. 
  6. Click "Update" in line with the secondary insurance. 
  7. Click "Update Insurance Payer"

How to Create CMS-1500 for Secondary Insurance 

To print a CMS-1500 form for secondary insurance when the primary claim was submitted by EDI, go to the patient's chart under the "Patient Billing" tab.

  • To generate a CMS-1500 for secondary insurance for a single date of service: 
  • Click into the date of service > "Create CMS-1500 for Secondary Ins."  
  • To generate a CMS-1500 for secondary insurance for multiple dates of service: 
  • If there is no partial payment on file: 
    • Click into the date of service > Change the "Method" dropdown to "Insurance - In/Out of Network - Paper" > "Save Changes"
    • Do this for each date of service under the "Patient Billing" tab, then click "Create CMS-1500".
  • If there is a partial payment on file: 
    • Click into the date of service > Change the "Status" dropdown to "Pending Initial Submission" > "Save Changes" > Click into the date of service > Change the "Method"dropdown to "Insurance - In/Out of Network - Paper" > "Save Changes"
    • Do this for each date of service, then under the Patient Billing tab click "Create CMS-1500".
  • Once on the "Create CMS-1500" screen
  • Check off the dates of service to include. 
    • Note: TherapyNotes batches up to 6 dates of service per patient onto a single CMS-1500 form.
  • From the "Document Format" dropdown select whether or not to include the red background.
  • Click the green "Download" button to download the CMS-1500 form(s). 
  • Follow the normal downloading steps for your internet browser. The files download into your computers "Downloads" folder.
  • Open the file in a PDF viewer.
  • Proofread the CMS-1500 carefully. 
  • Print and mail it to the payer's paper claims address, along with a copy of the explanation of benefits (EOB) or electronic remittance advice (ERA).  

Enter Insurance Payments 

Once insurance pays out the claim, enter and allocate the payment into TherapyNotes. For a visual tutorial on entering insurance payments, see this article


How Secondary Insurance Works in the Insurance Aging Report 

In TherapyNotes there is not a way to assign an insurance amount to a secondary payer. That means that the Insurance Aging Report balance that is the responsibility of a secondary insurance appears under the primary insurance on the claim.

For example, say a patient has Aetna as their primary insurance and AARP as their secondary. The total insurance amount is $100. Aetna pays out $70 and that insurance payment has been entered into TherapyNotes. Under the Insurance Aging Report the outstanding $30 is listed as the responsibility of Aetna, not the secondary AARP plan. This means the outstanding balance for primary insurers includes balances owed by secondary insurers. 

To locate the report, go to:

  • Click BILLING > "Insurance Aging Report" 

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