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Coordinating Primary and Secondary Insurances

Answered

Comments

6 comments

  • Ben

    Hi Kim,

    My name is Ben. I'm an Insurance Specialist here at SimplePractice.

    In this particular situation, it would be best to verify this information directly with the primary and secondary payers.

    That being said, if you are enrolled in Payment reports (ERAs), this information would be automatically calculated for you and then applied to the client's balance accordingly.

    If you have any additional questions, you're welcome to reply to the email that just arrived in your inbox.

    I hope you enjoy the rest of your day.

     

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  • Amy Koziarski, LISW, LLC

    My question is - do we HAVE to accept secondary insurance as an option?  Situation is client has 2 insurances primary is great insurance with great pay out, secondary insurance is terrible insurance with terrible pay out.  The secondary also does not allow for billing a no show appointment.  Do I HAVE to utilize the secondary insurance or stick with primary and they deal with whatever comes of the secondary insurance.  

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  • Yolanda Winfield

    Amy,

    If you are out of network, you are not obligated to bill them for the secondary. However if you are in network with the secondary, i would review your contract for the fine print. You might have to bill them. It all boils down to how your are contracted with the insurance carrier. 

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  • Robert J. Barden

    When I receive a secondary insurance payment when Medicare is primary, for some patients, the secondary insurance is listed in SP as a Medicare payment eventhough the secondary insurance is listed on their insurance profile.  These claims are automatically sent from Medicare to the secondary insuror.  I can't seem to figure out how to get SP to list these payments as secondary rather than another Medicare payment.

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  • Ruth

    Hi Everyone - If your client has a Medicare crossover plan, then you won't need to submit the secondary insurance claim. The claim will automatically get sent over to the secondary insurance plan without you having to create the secondary claim through SimplePractice. Regardless, I'd recommend submitting a Help Request with our Insurance Team so they can investigate what kind of secondary insurance plan your clients have and how to best bill for them. 

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  • Carolyn Evans

    I have a situation in which the primary insurer pays a lower reimbursement than the secondary. Additionally, the primary has been sent to clients deductible, so I bill to secondary insurer. Some of my claims have been paid at the secondary insurer's rate, others are rejected with the following. HELP!

    COB SERVICE LINE BALANCING IS FAILED CHARGE AMOUNT (LINE ITEM CHARGE AMOUNT)

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