Secondary Insurance

When secondary insurance is on file for a client, TherapyNotes includes instructions on all electronic claims for the primary payer to forward the explanation of benefits (EOB) or electronic remittance advice (ERA) and the claim itself to the secondary payer to help you better accommodate your clients.

Here is the typical workflow for submitting claims to secondary insurance in TherapyNotes:

  1. Your practice submits an electronic claim to the primary payer that includes information for both primary insurance and secondary insurance. The claim includes information about the secondary payer (payer name, paper claims address, and the insured's ID) and instructions for the primary payer to forward the necessary information to the secondary payer electronically.
  2. The primary payer sends an EOB or ERA to your practice and pays your practice a portion of the insurance balance owed.
  3. The primary payer forwards the EOB or ERA and the claim to the secondary payer electronically.
  4. The secondary payer sends an EOB or ERA to your practice and pays your practice a portion or the entirety of the remaining insurance balance owed.

If the primary payer does not forward information to the secondary payer:

Despite the instructions included on the claim, primary payers may not always forward the necessary information to the secondary payer. If you have received payment from the primary payer and have not yet heard anything from the secondary payer within a week or so, you may choose to:

  • Call the primary payer's electronic claims department and ask why they haven't sent the information to the secondary payer even though TherapyNotes instructed them to do so in the 5010 EDI claim file.
  • Or, generate a CMS-1500 for secondary insurance in TherapyNotes and print and mail the paper CMS-1500 and a copy of the EOB/ERA from the primary payer to the secondary payer. We've included instructions for this process later in this article.

Before submitting claims to secondary payers, ensure that the secondary insurance information is included in the appropriate clients' charts and, if necessary, verify that any billing line items that have already been submitted are updated to include secondary insurance information. Below, we've included instructions to add secondary insurance information to a client's chart, update billing line items with secondary payer information, and create, print, and mail CMS-1500 forms to secondary insurance.

Role Required: Practice Biller

Add Secondary Insurance Information for a Client

Any payer that you have added to TherapyNotes can be included as a secondary payer in a client's chart. Once secondary insurance has been added to a client's chart, TherapyNotes automatically updates the insurance information for any billing line items with the status of Pending Initial Submission and Pending Resubmission.

To enter secondary insurance information for a client:

  • Click Patients > Patient name > Billing Settings tab
  • Click anywhere on the Insurance box to edit.
  • Click the +Add New Insurance Policy button..
  • Select the secondary Payer and choose Secondary from the Priority dropdown.
  • Enter the relevant insurance information for the client in the Policy Information section. For more information, read Manage Client Billing Settings.
  • Click the Save Changes button.

Update the Secondary Payer Associated with a Billing Line Item

While any pending billing line items are automatically updated once secondary insurance is added for a client, items that have already been submitted to the primary insurance need to be updated to include the client's secondary insurance.

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

  • Click Patients > Patient name > patient Billing tab
  • Under Search Billing Transactions, click on the date of service.
  • A dialog with additional details about the date of service appears. The Billing tab should be selected.

  • Choose the desired secondary insurance policy from the Secondary dropdown menu.
  • Click the Save Changes button.

Please note that in order to remove secondary insurance from a submitted billing line item, you must first remove the secondary insurance information from the client's Billing Settings tab and then follow the above instructions.

For more information, read Update Payer per Billing Line Item.

Manually Bill Secondary Insurance Through TherapyNotes

At this time, TherapyNotes cannot submit secondary insurance claims electronically. Once a claim has been submitted electronically to the primary payer, you have received the partial insurance payment from the primary payer, and you have confirmed that the primary payer has not forwarded the claim to the secondary payer, create a CMS-1500 through TherapyNotes and mail this to the secondary payer.

To create a CMS-1500 claim for a secondary payer:

  • Click Patients > Patient name > patient Billing tab
  • Click the date of service you want to create the CMS-1500 for.
  • A dialog with additional details about the date of service appears. The Billing tab should be selected.
  • At the bottom of the dialog, click the Create CMS-1500 for Secondary Ins. link.
  • TherapyNotes will prepare your document in a blue bar at the bottom of your browser. When your CMS-1500 is ready, click the Ready: Click to Download link.

To create a CMS-1500 claim for a secondary payer for multiple dates of service:

  • Click Patients > Patient name > patient Billing tab
  • If there is no insurance payment on file for the date of service:
    • Under Search Billing Transactions, click on the date of service.
    • From the Method dropdown, select In Network - Paper or Out of Network - Paper.
    • Click the Save Changes button.
    • Repeat the above steps for the appropriate dates of service.
  • If there is a partial insurance payment on file for the date of service:
    • Under Search Billing Transactions, click on the date of service.
    • From the Method dropdown, select In Network - Paper or Out of Network - Paper.
    • From the Status dropdown, select Pending Submission.
    • Click the Save Changes button.
    • Repeat the above steps for the appropriate dates of service.
  • Under the patient Billing tab, click the Create CMS-1500 link.
  • Select the Include Secondary Claim checkbox next to the claims you want to include on the CMS-1500 for the secondary payer.
  • Click the Download CMS-1500 button. The CMS-1500 will download as a PDF.

  • TherapyNotes will prepare your document in a blue bar at the bottom of your browser. When your CMS-1500 is ready, click the Ready: Click to Download link.
  • Open the CMS-1500 PDF and review the information carefully. Then, print and mail the CMS-1500 to the payer's paper claims address along with a copy of the explanation of benefits (EOB) or electronic remittance advice (ERA) from the primary payer.

For information, read Create CMS-1500 Claims.

Once you receive payment from the secondary payer, remember to enter and allocate the payment in TherapyNotes. For more information, read Enter Insurance Payments.

Secondary Insurance in the Insurance Aging Report

At this time, TherapyNotes cannot assign an insurance amount to a secondary payer. Because of this, the outstanding balance for a primary payer on the Insurance Aging Report may include the balance owed by the secondary payer.

For example, imagine a client uses Aetna as their primary insurance and AARP as their secondary. The total insurance balance for a date of service is $100. Aetna pays $70 of the balance, and that insurance payment has been entered into TherapyNotes. In the Insurance Aging Report, the remaining $30 of the balance is listed as the responsibility of Aetna, not the secondary AARP insurance.

To access the insurance aging report, click Billing > Insurance Aging Report.

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