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" 
Have more questions? Submit a request


  • Avatar
    Regina Moore

    How to Manually Update the Secondary Payer in a Billing Item - THIS IS NOT WORKING, WHEN I ATTEMPT TO DO THIS, SYSTEM SAYS CANNOT CHANGE OR UPDATE.

  • Avatar


    If the date of service already has an insurance payment allocated to it, TherapyNotes will not allow the item's payer to be updated. If you need to update the payer in this case, please delete the insurance payment that is allocated to the date of service. Then you can go back in to the date of service under the "Patient Billing" tab and click "Update". After that, re-enter the insurance payment. ​

  • Avatar
    Shannie Smith

    Can you bill only the secondary insurance? A client has primary and we cannot accept that insurance, but we can accept the secondary. Is there something special for me to make this work?

    thank you,Shannie

  • Avatar
    Sean Behan

    Hi Shannie,

    You will need to bill to the primary first, even if you are out-of-network. The primary insurance may include an out-of-network benefit, or you may get a rejection. Once you have the response from the primary insurance, you would send the EOB with the paper claim to the secondary insurance.

    Please let us know if you have any other questions. Thank you.

  • Avatar
    Tabatha Masters

    I need for my cms-1500 to move down from box21 down. how do i go about this. I have 1-20 aligned.

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    Charlotte Davis

    I also need help with cms-1500 for secondary claims, or the ability to print with the background would be a better option. Thank you!

  • Avatar
    Sean Behan

    Hi Tabby,

    Please be sure that you do not have any scaling or "fit to page" features enabled when printing. The document should always print at 100% zoom.

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    Sean Behan

    Hi Charlotte,

    One our support staff will reach out to you to help resolve your issue.

  • Avatar
    Jason Kaczmarek

    All of the insurance companies that we submit claims to as primary do not forward claims onto the secondary insurance, and then some of the secondary insurances do not have a provider portal to submit theses secondary claims electronically and none of the insurances accept paper claims anymore. Just curious why the secondary processing doesn't take place at the clearinghouse level, since everything is being submitted through the clearinghouse. Isn't there an electronic stream lined process for the secondary billing so that we don't have to do everything manually. Processing secondary claims requires a lot of paperwork and time.

    Edited by Jason Kaczmarek
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    If the payer does not accept secondary claims through their portal or paper, please send us the payer information along with documentation stating this, and we can look into this for you. We are planning to add secondary EDI claims as future improvement, however any payers that we are aware of that do not accept paper claims do permit submitting claims through their portal. The secondary processing is not handled at the clearinghouse level because the secondary claim must contain information from the primary claim, such as the amount primary insurance has paid, which is why you need to send an EOB from primary when submitting secondary claims manually. If you have any questions please contact support at 215-658-4550 or via email at Thank you.

    Edited by Jordan
  • Avatar
    Diana Moreland

    My client changed insurance companies. How do I up load a new insurance card?

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    A new insurance card can be uploaded by Clicking the Documents tab on the patients file > Upload Patient File > Click with the 'Document Name' field and select 'Insurance Card' (for secondary insurance, select "Insurance Card - Secondary") from the drop down list > Click 'Choose File' to select the document from your computer > 'Add Document'. If you have further questions, please contact our Support Team at 215-658-4550, or by email at Thank you.

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    Linda Smith

    We are having an issue with BCBSM secondary claims. They are requesting that we use different information in two areas of the 1500 forms.. We cannot hand write the information as they said it would not be accepted. We cannot bill directly through them for secondary claims per their response. How can we make a default 1500 form with the required information to be used for secondary claims so that we can get these processed.

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    A member from our Success Team will reach out to you directly to assist you in resolving this issue. Thank you.

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    Jamie Wurtzberger

    Do you have an ETA of when the secondary EDI will be implemented? I know you mentioned it about 7 months ago in this thread, so I thought I would check in. Thank you!

  • Avatar


    We do not currently have an estimate for the release of this feature. If you have further questions, please contact our Success Team at 215-658-4550 or by email at Thank you.