Tips for submitting secondary claims electronically

You’re already sending us your primary claims electronically. Did you know that we can accept your secondary, or coordination of benefits (COB), claims electronically, too? In fact, we prefer that you send us your secondary claims electronically. When you send us the right information up front, we process your secondary claims faster. And when we process claims faster, you could get your claims payments faster, too.

What we need (and what we don’t)

First, ask your patients whether they have other coverage. They might forget to tell you. Without that information, your claim payments could be denied or delayed. Once you learn about their other coverage, we’ll need some information on the patient’s primary plan and what they may have already paid you. (We’re looking for this information in the 2320 and 2330 loops of the electronic claim transaction. Check with your software vendor to ensure you’re entering the information in the correct fields to transmit to us.)

If the patient has no other coverage, we ask that you leave those fields blank. Don’t enter non-COB information, such as information on discount programs or life insurance, in those fields. If you enter any incorrect information, we must verify the information ourselves. That takes time and may delay processing your claim.

Here are the fields we’re reviewing when the patient has another insurance plan, and we’re paying second:

Demographic information

• The other plan’s name
• The other plan’s policy number, if applicable
• The other employer’s name, if applicable

Financial information

• Payer-paid amount: When we pay second, we need to know the amount the primary carrier paid you. This amount is equal to total charges minus claims and line-level adjustments. Be sure you don’t confuse the payer-paid amount with the patient-paid amount.
• Patient-paid amount: These amounts include those applied toward deductibles, coinsurance amounts and copayments.
• Line-level-adjustment reason codes and associated amounts (professional claims only): These show why the other insurer paid less than billed. Amounts include those applied toward deductibles, coinsurance amounts, copayments and any write-offs.