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Processing a Primary Adjudication for Submission to a Secondary Payer on File

Version 14.19
Path: Billing tab > Billing Center button > Adjudications tab

Overview

When you are posting ERA payments, there may be instances when there is a patient responsibility due. If the patient holds other coverage, the practice will likely send that responsibility to the Secondary Payer on file. To do this, follow the below steps:

  1. Navigate to the Adjudications in the Billing Center using the path above.
  2. Select the Adjudication line where the patient's secondary insurance is listed.
  3. Expand the Adjudication to see the patient's responsibility is displayed.
  4. Ensure the following:
  • The patient's responsibility amount is listed in the Pt. Rsp. and Pat Bal. columns.
  • Xfr sec: is displayed in the Insurance Action field with the secondary insurance listed.
  • Hold on account is displayed in the Patient Action field.
  1. Approve all Adjudications for the claim.
  2. Click Post Paymt. The secondary claim sits in the Transmit Queue waiting for electronic submission or print.
Note: For payers not accepting electronic secondary submission, click the CMS-1500 button to print a paper claim. Mail it with a copy of the EOB/ERA received from the primary carrier. Generally, you should be able to obtain a copy of the corresponding EOB (for this ERA) on your clearinghouse or payer website.
Version 14.10
Path: Smart Toolbar > Billing button > Adjudications tab

Overview

When you are posting ERA's payments back in to Office Practicum, there may be instances where there is a patient responsibility due. You can use the note field to keep track of any information you need to maintain based on the primary adjudication. For example, primary payer assigned patient due co-payment, deductible or co-insurance. However, if the patient holds other coverage the office most likely will want to assess any remaining responsibilities to the Secondary Payer on file and send the claim out electronically to the other payer on file. To do this, follow the below steps:

  1. Click the Billing button on the Smart Toolbar to open the Billing Center.

Smart Toolbar: Billing

  1. Click the Adjudications tab.
  2. Click the Expand button  to open the Adjudication details of the Claim.
  3. Notice in the column for Sec Ins, a payer other than the primary payer listed.

  1. Approve all Adjudications for your claim.

 Adjudications tab

  1. Click the Post Payment button  .
  2. Click the Transmit Queue tab if the payer accepts electronic secondary claims.
  3. Click the Create Files button to send the Claims. The Claims include all primary payment details.
  4. Click the Yes button to Create claim files for transmission to payers and click the Yes button to Transmit now.

Note: For payers not accepting electronic secondary submission, click the CMS-1500 button to print a paper claim. Mail it with a copy of the EOB/ERA received from the primary carrier. Generally, you should be able to obtain a copy of the corresponding EOB (for this ERA) on your clearinghouse or payer website.