Secondary Billing Total same as Primary

Day-to-Day Users
1

ajperezcrespo wrote on Tuesday, May 15, 2012:

Hi,
   I noticed that when a claim has a secondary billing, the total amount is the same as the original.  Should it not be the initial amount minus the amount billed to the primary insurance?  For example if the initial claim was for $100.00 and the primary insurance company payed $25.00 then wouldn’t  the secondary billing 1500 claim total be $75.00?

Thanks
Alfonso

2

kevmccor wrote on Tuesday, May 15, 2012:

I believe the primary insurance payment is supposed to be in the CAS segment following the CLM segment.  Also, the secondary can query the primary, which I assume they do.

Good question.

3

ajperezcrespo wrote on Wednesday, May 16, 2012:

The end result will be that we are over billing or getting underpaid.  If I have two bills for the same claim (ie Claim X has two bills (Primary and Secondary) each for 100.00.  That’s 200.00 but our claim is really only for 100.00.

Clarification Please?

Thanks

4

kevmccor wrote on Friday, May 18, 2012:

I am no expert on this and don’t know for sure, but overpayments from ins co’s are rare or non-existing in my experience.  If you get some paper RA’s from secondaries, you will likely see the total fee and primary adjustments/payments listed as well as the secondary benefit/payment.  If you have recorded payment from primary ins and generate secondary billing x12, you should see a CAS segment in the batch file for that patient, which should show the primary ins payments.  You are not going to get paid twice or be double billing.  The ins co’s know how to interpret the claims. 

Any knowledgeable experts out there?