Filing Secondary and Tertiary guarnatee Claims

Health Insurance Claim Form 1500 Instructions - Filing Secondary and Tertiary guarnatee Claims

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When we first started our curative billing business in 1994 I had no former palpate at billing any curative claims, let alone secondary and tertiary. (You mean some citizen have 3 insurances?) I knew nothing. In fourteen years of billing I've learned quite a bit and I see from questions in our forum that many beginners do not understand secondary and tertiary claims billing at all.

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Health Insurance Claim Form 1500 Instructions

First of all, how does anything get two or three policies and which is considered primary? If a husband and a wife both work (who doesn't?) and they are both covered by health assurance by their employers, they may both have family policies so they are both covered under each others plan. One would be customary and the other secondary. Now if one of this integrate (a few years ago we would have assumed that it would only be the husband) had former troops palpate and carried over their Tricare troops insurance, that would be the third payor (if there was a equilibrium left).

Which business is customary and which one is secondary is considered by one of a integrate dissimilar methods. First of all, if a person is working and they carry insurance, that assurance is customary (unless they have Medicare and their boss has less than 100 employees). If a person is retired and has Medicare but the spouse works and carries a family policy, then the spouse's plan would be customary and the Medicare would be secondary.

There is no way to cover every scenario but basically either or not the person or the spouse is working can decide the order. For dependents (usually children) some go by the "birthday rule" meaning that whichever parents birthday falls first in the year is primary. Of course with all of the divorce out there sometimes the order of assurance is considered by a court order.

When a outpatient is seen by a victualer the claim is sent on a Cms 1500 form to the customary assurance carrier either electronically or on paper. Electronically it can be sent either directly to the assurance carrier by extra software or straight through a aid or straight through a clearing house. When sent on paper it simple means the claim is printed to a paper Cms 1500 form and sent straight through the mail. anything the case is, it is important that you know the order of the policies.

Once the customary assurance carrier pays their share of the claim it is then submitted to the secondary assurance business if the outpatient has one. Secondary claims can also be sent electronically and on paper. Medicare is mandating electronic submissions even on secondary claims. When submitted electronically all the data from the eob (explanation of benefits) is entered into the claim data and submitted to the secondary assurance carrier.

When the secondary is submitted on paper, the claim is printed out again on a cms form and a photocopy of the eob is attached. If other patients are listed on the eob, their personal data should be hidden. Many offices use black markers (we call them smelly pens) to draw straight through the unwanted information. I've set up a bunch of varied width strips of white cardboard that we slide into clear narrative covers to cover the unwanted data before we photocopy. We only do this with associates that are not yet accepting electronic submissions.

If there is still a equilibrium after the secondary assurance carrier pays their share, the claim is sent on to the third carrier. It is printed out again on a cms form and copies of the eobs of both the customary and the secondary assurance carriers are attached.

Whenever you send secondary and tertiary claims on paper, make sure the photocopies you attach are clear, easy to read, and for the literal, date of service. Many assurance carriers scan the eobs which lightens them a little. If the copy you submitted was already light, by the time the claim is processed it may be sent back to you as unreadable. It takes a lot more time to find the customary eob and resubmit a claim than it does to get it right the first time.

Secondary and tertiary claims can sometimes seem like a pain to get paid - especially because they can be for a very small number of money. It is still important to file and track these claims to keep your receivables under control. It may not seem like a lot of money but it adds up. If you have a theory for submitting them it categorically isn't that bad.

I hope you receive new knowledge about Health Insurance Claim Form 1500 Instructions. Where you may put to use in your evryday life. And just remember, your reaction is passed about Health Insurance Claim Form 1500 Instructions.