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How to Send Tertiary (or beyond) Claims

The ReLiMed Billing module is not set up to be able to send Tertiary claims electronically. Therefore, these claims will need to be sent via paper.

 

Once you  have received EOBs from both the Primary payor and the Secondary payor, you can follow these steps to send in the paper claim form to the Tertiary payor. 

 

1. From Billing -> Edit Claims, select the claim you need to send to Tertiary. 

2. Make sure the Payor is set to the Tertiary payor in the drop down on Claim Details:

 

 

3. Set the appropriate fields in the "Overrides" dropdown for each line item as you normally do for a secondary claim:

     a. Add Primary + Secondary Pmt for the payment amount

     b. Add Payment date as date of secondary payment (or primary if secondary did not pay)

     c. Make sure PayorID shows secondary payor (or primary if secondary did not pay)

     d. Check under "Rebills/COB" for claim level total amount paid and last payor's payorID

 

4. Print the claim form by selecting the "Print Paper" button and save it as a pdf

**Many times you can get a fax number from the payor to be able to fax these, so printing on an actual red HCFA1500 form is often unnecessary.

However, if you have to print and mail these, then you should select "Yes" to the pop-up question to print on a form and feed in the proper blank form to your printer. 

5. Print the EOB from the Primary payor and save it as a pdf

6. Print the EOB from the Secondary payor and save it as a pdf

7. Fax or mail these to the appropriate Tertiary payor

 

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  • 09-Apr-2024
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