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

Version 14.8
Path: Smart Toolbar > Billing button > Adjudications tab


When a user is 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 copayment, 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. Open the Billing Center by clicking on the Billing button on the Smart Tool Bar.

Smart Tool Bar: Billing

  1. Click on Adjudications tab.
  2. Open the Adjudication details of the claim by clicking on the expand button .
  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 on Post Payment button  .
  2. If the payer accepts electronic secondary claims, click on the Transmit Queue tab .
  3. Click the Create Files button to send the claims. The claims will include all primary payment details.
  4. Click Yes to Create claim files for transmission to payers and Yes 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.