Billing Secondary & Tertiary Claims

Michaela Siebert

Apr 15, 2025

Billing Secondary Claims

COB Overrides are done on all secondary claims.

IF claims come in as ERA most areas are prefilled.

Manual posting and $0.00 payments will have to be filled in manual

Below is an example Claim to Medicare as Primary and shows the transactions after Medicare adjudicated the claim:

The claim is now showing a balance due from Secondary (AARP) as $17.01 after Medicare paid $69.06 and adjusted $116.93

To now submit this secondary claim to AARP, we follow the steps below. These steps should be followed each and every time and you need to send a Secondary claim.

From the Billing -> Edit Claims screen, Search and select the claim that needs to be filed to Secondary. It will have a green R to indicate it has already been transmitted once:

Select the Rebills/COB tab and review your fields going down the list:

Payor ID- this is the primary insurance EDI payor id. This field is prepopulated but can be edited if needed.

**This should MATCH the Payor ID of the Primary Payor

Payor Paid Amt- this is the grand total amount paid from the primary insurance. This field is mandatory.

For our example claim, this tab will need to have the following information:

Notice you are shown a panel labeled “Coordination of Benefit (Primary COB) Fields”

We make sure to include Medicare’s Payor ID and Paid amount which is at the claim level.

3. Once completed, go back to Claim Details and you will be prompted to save.

Always click yes to save.

This is very important!

5. For each line item (CPT Code billed), you will need to set the Line Item COB settings, scroll to the right and click on the down arrow in the row the line item with the column heading of “Overrides”:

6. This will bring up a pop-up window. The system will try to pull what is can from the Primary Claim if it was Auto-posted from the ERA.

You will still need to check each field and then click OK to save the values.

*** It will be very important to Save the System suggested overrides - you will notice the label in RED when they have not been saved yet:

Once you have edited the fields to represent the proper amount per line item, be sure to click on the OK button shown above. This information per line item should come directly from the ERA/EOB from the Primary payor. For our example, we have populated line item 1 as:

Every line item will need balance with the following equation:

Charge amount – Payor Paid Amt – Sum of Contractual adjustments Amt fields – Sum of Patient Responsibility Amt fields = 0

$125.00 - $64.06 - $43.93 - $17.01 = 0

Make sure you have the total Remaining Patient Liability Amt in the top right-most field.

Also make sure the Payor Paid ID equals the one that was on the Claim level Payor ID. It can only be changed from the Rebills/COB claim level tab.

7. Review all line item overrides and make sure to click on OK for each one and review the Payor ID and Payor Paid Amt on the Rebills/COB tab.

8. Finally, make sure the claim is set to the next payor in line (Secondary payor) to be sent.

Mark it Ready to Bill on the Claim Details tab:

Billing Tertiary Claims

This is a similar process to the Secondary claims process. However, this time you will be making sure to not only include all the information from the Primary ERA/EOB at claim level and line item levels, but also from the Secondary ERA/EOB at claim level and line item levels.

Below is an example Claim to Medicare as Primary and shows the transactions after Medicare adjudicated the claim, and also after AARP as Secondary adjudicated the claim:

Now we can see the payor is set to Tricare for Life (Tertiary) and AARP paid $0 and passed $17.01 onto the patient due to Coinsurance. If you look at the EOB, you will also see adjustments that are representing what the primary payor paid and adjusted.

To now submit this claim to Tricare, we follow the steps below.

From the Edit Claims screen, search and select your claim and go to the Rebills/COB tab.
Review your fields going down the list:

Payor ID- this is the secondary insurance EDI payor id. This field is prepopulated but can be edited if needed.

**This should MATCH the Payor ID of the Secondary Payor

Payor Paid Amt- this is the grand total amount paid from the secondary insurance. This field is mandatory.

For our example claim, this tab will need to have the following information:

Notice the panel labeled “Coordination of Benefit (Primary COB) Fields” is now disabled and a new panel is shows labeled “Coordination of Benefit (Sec COB) Fields” to represent how the secondary paid on this claim.

We make sure AARP’s Payor ID and Paid amount which in this case is $0.00 is entered.

3. Once completed, go back to Claim Details and you will be prompted to save.

Always click yes to save.

This is very important!

6. This will bring up a pop-up window. The system will try to pull what is can from the Secondary Claim if it was Auto-posted from the ERA. NOTE, now you will be presented with a panel labeled “Secondary COB Fields”

You will still need to check each field and then click OK to save the values.

*** It will be very important to Save the System suggested overrides - you will notice the label in RED when they have not been saved yet:

Once you have edited the fields to represent the proper amount per line item, be sure to click on the OK button shown above. This information per line item should come directly from the ERA/EOB from the Secondary payor. For our example, we have populated line item 1 as:

NOTE: you need to make sure you have the contractual adjustments from the ERA/EOB represented in the above fields even though those are not posted with the secondary since those adjustments are already posted as transactions with the Primary.

Every line item will need balance with the following equation: