Secondary Balances

Purpose

To ensure the proper procedure is utilized once a claim is submitted to the secondary payer and has aged to 60 days or more.

Policy

Post primary claim adjudication, the secondary payer will be billed for the remaining claim balances if appropriately loaded in Insight Billing. Some payers will electronically pass the claim to the secondary. If the payer does not pass the claim to the secondary, Clinicient will do so.

Secondary payers require the primary payer’s Explanation of Benefits (EOB) or a breakdown of the payments/contractual adjustments to verify accurate adjudication.

The balance will be transferred to the patient once it has been identified that the secondary payer has not been responsive. This includes:

  • no transaction posting response
  • and the balance has aged to 60+ days from the date of submission to the secondary

An A/R representative will follow up with the payer within the aforementioned timeframe before transferring the balance to the patient.

This policy is applicable to all claims with the exception to Motor Vehicle Accident (MVA), Workers’ Compensation, and Letters of Protection.

Secondary Insurance Definition

It is the patient’s responsibility to inform the clinic of any secondary insurance coverage prior to their appointment. When a claim has been adjudicated by the primary insurance, any remaining balance will fall to the secondary insurance in Insight Billing. Clinicient will submit the aforementioned claims to the secondary insurance if not automatically passed on by Medicare.

 

Clinicient (the “Company”) is providing this information for general guidance. The application, impact and change of laws can vary widely. Accordingly, the information is provided with the understanding that it is not offered as legal or any other professional advice or services and as such should not be used as a substitute for consultation with professional and licensed advisers. While we have made every attempt to ensure that the information contained herein is accurate at the published time, the Company is not responsible for any errors or omissions, or for the results obtained from the use of this information. All information is provided "as is," with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use of this information, and without warranty of any kind, express or implied, including, but not limited to warranties of performance and fitness for a particular purpose. In no event will the Company or its subsidiaries, agents or employees thereof be liable to you or anyone else for any decision made or action taken in reliance on the information.

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