When billing insurance for your clients, it’s important to understand the difference between primary and secondary insurance. By educating yourself on the ins and outs of secondary insurance, you are equipping yourself with the knowledge and confidence to successfully submit insurance claims for your clients. Luckily, we’ve made it easy for you with this list of frequently asked questions.
If a client has multiple insurance coverages, the payer responsible for first paying the claim is called the primary insurance and the second payer is called the secondary insurance. If you are in-network with the primary insurance payer, the primary will pay for their portion of your contracted rate as dictated by the client’s insurance plan. The secondary insurance payer will often cover a portion of the remaining balance, which often includes the client’s copay.
There are many examples of why a client may have more than one form of health insurance coverage. A common example is if a client has insurance through their employer and also has coverage through their spouse, meaning that they have both primary and secondary insurance.
The client doesn’t get to pick and choose which insurance is primary and which is secondary, this is determined by their insurance payers. Typically, the primary insurance will be the insurance plan under which the client is the primary subscriber. In our example of the client with coverage through both their employer and their spouse, the client’s primary insurance would likely be the plan through their own employer and the secondary insurance would be the coverage through their spouse.
When a client has more than one form of insurance coverage and one of those plans is through Medicaid or TriCare, the TriCare or Medicaid coverage is most likely the secondary insurance plan. Medicare plans can be either primary or secondary coverage, depending on the client’s situation. If you are ever unsure of which insurance coverage is a client’s primary or secondary, we recommend that you reach out to the payers to find out from them directly.
It is a common mistake to think that primary and secondary insurance claims get billed out at the same time. However, this is incorrect. When billing for primary and secondary claims, the primary claim is sent before the secondary claim. Once the primary payer has remitted on the primary claim, you will then be able to send the claim on to the secondary payer.
If you are unsure of why your secondary claim has been rejected, we recommend reaching out to the secondary insurance payer to learn more. However, the most common secondary claim rejection usually looks like this: “Secondary Claim Information Missing or Invalid, Line Charge Amount = Line sum of Adjustment Amts + Line Payer Paid Amt”.
This rejection means that the total billed amount of the secondary claim does not balance with the primary payment amount and claim adjustments. When sending claims on to the secondary payers, the payer wants to see the total billed amount of the claim, the amount the primary insurance paid on the claim, and the reasons why the billed amount was not paid fully by the primary payer. In order to communicate the reasons why the billed amount was not paid in full by primary, your claim will need to have adjustments to indicate the categories of the remaining balance. If you receive this rejection, you will need to review and correct the claim adjustments listed on your secondary claim.
If you’re interested in the ways that My Clients Plus can help you with insurance billing for your practice, click here to learn more.