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A good number of provider offices are still submitting secondary claims on paper rather than electronically for a variety of reasons.  Today’s tip was written with the goal of reducing the number of denied secondary paper claims by making just a  few simple changes.

Basic information

Secondary Claim Tips
Secondary Claim Tips

New billing staff should understand that the secondary insurance plan cannot process the claim without a copy of the primary carrier EOB.

  • In most cases stapling the primary EOB to the claim at  the  upper right hand corner works well.

  • Be sure to de-identify information about other patient claims which may also appear on the same page of the EOB.  This may be done with a black marker or white out and can also be done electronically and then printed out,  if the EOBs have been stored electronically.

Carrier denies stating no primary EOB was attached

Unfortunately, this happens all too often. It appears that somewhere in the stream of processing the claim, that the EOB was removed from the claim at the carrier site. What to do?

  • Invest a couple of bucks in a stamp that says, “PRIMARY EOB ATTACHED”, and stamp the claim form itself in an area where it does not cover any pertinent information printed on the claim form.

  • Stamp the envelope as well

  • Follow up with the carrier and ask them to take a look at their scans and see if the EOB is not there since you are certain that it was attached—many times the customer service rep can see that the EOB really is there and send it back for reprocessing.

Multiple Paper Claims Submitted with One Primary Payer EOB

A recent Medicare alert was sent out concerning this situation and I have inserted it here word for word (italics added):

“To prevent unnecessary claim denials, please refer to the following steps when submitting multiple paper claims for a Medicare Secondary Payer (MSP) patient:

  • When multiple claims are processed on one primary payer Explanation of Benefits (EOB), make additional copies of the EOB for each claim form being submitted to Medicare.
  • Attach a copy of the primary payer’s EOB with each claim form.

When multiple claim forms are submitted to Medicare, the forms are separated and processed individually. If only one copy of the primary payer’s EOB is submitted, then only one of the claim forms will process with primary payer information.”

This rule of thumb should be followed for all carriers, not just Medicare. Failure to make the additional copies and attach to each claim form will almost certainly result in denials.

Medicaid

Keep in mind that while there are always exceptions to every rule,  in most cases, Medicaid carriers will not process claims that have items stapled to them. The claims could be denied, but in many cases, they will not be processed at all.  For Medicaid secondary claims, please use a paper clip or do not attach at all. I like using a paper clip when multiple claims are submitted in the same envelope because it still keeps the EOB attached to the correct claim up until the point the items are scanned into the carrier system without disrupting their processes.

Happy billing!

Happy Billing!
Happy Billing!