Hello!
I am trying to figure out exactly what checking “Needs secondary billing” on the EOB invoice screen actually does. It appears that, when the checkbox is checked, the claim is re-opened. I am guessing that the biller can then go to the Billing Manager and search for unbilled claims and it would pop up. Am I getting it right or are there other fields that get changed, too? However, if the billed status changes to “unbilled”, it would also open the claim to become modifiable in terms of coding. Am I correct or am I missing something?
The reason I ask is that I would like to automate the following. If a crossover does not occur as indicated in the era file ($out[‘crossover’]=0) and the patient still has more insurances that need to be billed, either the “billed” column in the billing table get switched to 0 or something else happens where I can pull such claims up in the Billing Manager as “Unbilled” or a combination of some other criteria (maybe “Unbilled”, “Last Level Billed” and “Authorized”?). When a crossover does occur, they would not come up in the Billing Manager, so the biller would not bill them.
It may very well be already happening in the system already (hopefully it is), but I don’t know the exact way to make it work. So if it’s already in place, please advise me on the process of finding these unbilled, non-crossover secondary or tertiary claims in the Billing Manager.
Thanks,
Alex.
Hi @cerber98, it’s already happening in the system.
To see the pending claims use the collection report. To see if it was forwarded you can expand the items in the billing manager to see the This claim has been forwarded to next level. message.
I don’t think it works quite like that. I just looked at an EOB from Medicare that I received 2 days ago. It lists some patient for whom crossover was done automatically by Medicare and some for whom it was not, but they have a secondary insurance. When I then go to the Billing Manager and check for Unbilled claims for either type of patient, none come up. So I cannot differentiate easily between those that have been crossed over vs those who have not and need to be submitted to the secondary (or tertiary). Ideally, I would like to receive an 835 file and, if crossover was done, they do not show up on the Billing Manager under Unbilled (or some other category). If crossover was not done, but they have a secondary or tertiary insurance, all those patients should come up in Billing Manager at once, so I can create a new batch and send them to the clearinghouse.
I hope this explains it better. Please let me know if I’m missing something…
Thanks,
Alex.
Hi @cerber98 If you’re posting from an 835 it will work like that. If you’re posting by hand then you need to check that box for 2ndary billing.
Thank you very much for explaining it. I will check it out. If it doesn’t work as expected, I’ll let you know.
Thanks again!
Checked. Yes, works as advertised 
Thank you for your help!