Secondary, Tertiary, and Mixed Payer Claims

Secondary/tertiary or mixed insurance claims are never created directly from the Charges tab. Instead once the primary insurance has paid their portion of the claim and the payment is posted, any balance remaining sits in the Billable category and is ready for you to bill the next payer (secondary or tertiary). Claims for secondary/tertiary payers are usually sent on paper along with a copy of the primary payer’s EOB. Claims can have charges within them that have a mix of payer indexes (some charges at primary and some at secondary for example). This can happen when primary pays a charge in full but leaves a balance on two charges for secondary insurance.

Best practice is to bill secondary or tertiary claims immediately after you post the explanation of benefits (EOB). This ensures that the EOB is readily accessible to attach to the claim. Clinicient also recommends working denials and short pays (this is when the payment falls short of what is expected by the payer) during and immediately after posting EOBs.

Use the instructions below to submit an On Hold claim to a secondary or tertiary payer.

  1. Optional: Filter the ActivePayer column to see only claims at Primary payer.
  2. Double click the claim you would like to send to the next payer.
  3. The Claim Editor dialog opens. Select Pass to Next Payer from the Action column for each line you would like to submit to the next payer. This sets the claim to Billable status.
  4. Select the Billable category, locate the claim and select the Bill button.

Use the Crossover button on the Claim Editor only when you need to manually set the claim to At Payer status and the primary payer has sent your claim directly to the secondary payer.

Related Links:

How to Bill Claims

Claim Processing Overview

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