Secondary Insurance Claims

You can submit secondary insurance claims electronically within TherapyNotes after receiving and posting a primary ERA. This guide will provide clear step-by-step instructions to help you complete the secondary insurance claim submission process.

• Getting Started
• Enrolling with Secondary Payers
• Configure Patient Settings for Secondary Insurance
• Submission Process
• Appointment Billing Details
• Submit Secondary Claims
• Prior Authorization
• Post-Submission
• Secondary ERA Payments
• Electronic Claim History
• Resubmit Secondary Claims

Getting Started with Secondary Insurance

Enrolling with Secondary Payers

Ensure that Claims Enrollment and ERA Enrollment are complete for the secondary payer. The enrollment process is identical to primary enrollment and is only required once per payer: 
See Enroll to Submit Electronic Claims and Enroll to Receive Electronic Remittance Advice (ERA) for more details. 

Configure Patient Settings for Secondary Insurance

1. Navigate to the Patient Tab.
2. Select the Patient name.
3. Click on the Patient Billing Settings Tab.
4. Confirm that the billing settings include primary and secondary insurance, and add an additional policy as necessary.

5. Navigate to the patient’s Billing Tab. In the Search Billing Transaction section, click on the date of service to open its dialog.

6. Click on the dialog’s Billing tab and manually set the secondary insurance method to the applicable electronic option for the policy:

• Insurance - In Network - Electronic
• Insurance - Out of Network - Electronic

Submission Process

Appointment Billing Details

Once the secondary insurance method is set, the information will appear on the Appointment Dialog Billing Tab as follows:

1. If the patient has secondary insurance, the Patient Responsibility field will populate based on the secondary policy settings. 

2. In-Network vs. Out-of-Network: 

If both primary and secondary insurance methods are In-Network, the system will display the standard rate and Patient Responsibility field. 

If one insurance method is Out-of-Network (OON), the system will display the Assignment dropdown. 

The Coverage field will only appear if both methods are set to Out-of-Network (OON). 

3. There are four statuses for secondary claims: 

• Pending Secondary Submission: Automatically displays when a secondary claim is ready for submission or can be manually selected. 

• Pending Secondary Resubmission: Displays for rejected secondary claims. 

• Secondary Submitted: Displays once the secondary claim is submitted. 

• Forward to Secondary: Displays when the primary payer forwarded the secondary claim. 

4. The Pending Secondary status will display in green when the electronic claim is ready for submission. 

• If the secondary method is set to Paper or External, you will see a static Pending Secondary status. 

• Click the Create CMS-1500 or Mark External Claims link to generate a CMS form or mark the claim as externally submitted. 

5. The Billing History tab in the appointment dialog provides a convenient location to access detailed billing information for a selected appointment. It provides a comprehensive history of all primary and secondary billing-related actions, complete with user and date/time stamps. 

Submit Secondary Claims

1. Submit the Primary Claim and wait for the receipt of the Primary ERA. For more information, see Submit Electronic Claims and Post ERA Payments.

2. Once the Primary ERA is posted, select a method to locate the secondary claim.

• To view claims ready to be submitted, click Billing > Submit Secondary Claims.
• To view claims ready to be submitted for a specific patient, click Patients > Patient Name > Billing tab > Submit Secondary Claims.
• To view claims ready to be submitted for a specific payer, Click Payers > Payer Name > Billing tab > Submit Secondary Claims.

3. Click on the green “Pending Secondary” link to open the claim information page:

4. Review the details and make any necessary changes, like adding a modifier.

Prior Authorizations 

Prior authorizations for secondary insurance are separate from primary since they are associated with the individual policy. Only primary prior authorizations will appear on the Submit Primary Claims page, and only secondary prior authorizations will appear on the Submit Secondary Claims page. 

Post-Submission

Secondary ERA Payments

TherapyNotes' assisted ERA payment posting feature is available for secondary payments. While TherapyNotes handles much of the heavy lifting, you remain in control of posting the payment. After TherapyNotes scans the ERA, you can review the details and decide whether to accept the suggested changes. The process works like posting primary payments – keeping things simple and consistent for you!

• Click Billing > ERA OR Click To-Do > Process ERAs. 
• Click the Post Payment link next to the ERA you want to process 
• Match all line items reading No Match Found 
• Review the information in the ERA Payment Poster 
• Click the Post Payment button

Electronic Claim History

The Electronic Claim History section provides a detailed view of the claim’s journey through the billing process, including its sequence and related primary or secondary claims.

• Sequence Column: A sequence column has been added to identify where the claim is primary or secondary.
• Primary ERA for Secondary Claims: If the claim is secondary, the Primary ERA is displayed within the claim information section in the header. This is clickable, allowing quick access to the primary claim’s details for easier reference.

Resubmit Secondary Claims

When the clearinghouse or payer rejects a secondary electronic claim, the claim status will automatically update. You can review details about why a claim is rejected on the Electronic Claim History page. After making any needed corrections, the claim can be resubmitted. 

• Go to Billing > Electronic Claim History and search for rejected secondary claims:

  Quick Tip: For more information about Claim History, see Electronic Claim History: Claim Status and Rejected Claims for more details. 
• Open the claim to review details and make any necessary adjustments.

• Select the appropriate Resubmission Type:  

  • New Claim means a newly resubmitted claim. 

  • Amended Claim means a corrected claim. Selecting this option puts the number 7 on the corrected claim. 

  • Void Claim should be used when the payer asks for a voided claim.

• Click Submit Claim.