Secondary Billing Using Revenue Management

Secondary Billing Using Revenue Management

Setting up your patient properly to send claims to the primary and then to the secondary insurance.

1. Add the primary insurance and mark it as bill insurance automatically

In this example, it is First Heath and the insured is self

2.  Add the secondary insurance and make sure to check the option "bill automatically after primary"

Notice: This is a Medicare secondary.  You must put the reason why Medicare is secondary by using the drop-down menu. 

 3. Make sure your insurance company is also set up for electronic billing.

When Medicare is primary, it will send the payer ID, and when it is used as a secondary, the payer ID must also be present in the Payer ID field for the secondary receiver.

 

Posting the Primary Insurance Payment

You must post the payment and adjustment to the actual TX Code.  You cannot add a line and post the payment as a line item.  It must be posted in one of three ways.  Auto posting, insurance payment posting, or going to detail and post payments. 

Ready to transmit your secondary claims using Revenue Management

1. Go to Billing > Revenue Management > Revenue Management
2. Click Select >Secondary > ready to send


3. You will see all your secondaries ready to go.

You see Rcvr2, which means secondary, and you see the receiver . In this case, it is EMCL. Also, notice there is a check mark in front of the chart number.  This is because the claim has already been processed through the scrubber with the primary and does not need to be rechecked. 

4. Now, click the send button, and it will prepare the claim to get transmitted.

Info
Once you have sent your secondary claim, you can go to Help at the top and click to reset the grids.

 

What the secondary outbound file looks like shows the COB information

In this claim case we see the following:

  1. CLM with the charge amount of 47.00
  2. AMT with the total claim amount paid of 23.00
  3. We also see the SVD with the line payment amount of 23.00
  4. CAS with the adjustment amount of 5.00
  5. CAS with the amount remaining of 19.00 that the secondary insurance should pay
  6. The COB or coordination of benefits add up by charges – payment – adjustment = amount remaining
  7. 47.00-23.00-5.00 = 19.00   This is a clean claim.  We do not expect this to be looked at each time,   this is just an understanding of how they get your EOB in the claim file.

 

ISA*00*          *00*          *ZZ*GBA*ZZ*12345678*250923*1237*^*00501*000000001*0*P*:

GS*HC*GBA*GBA*20250923*1237*1*X*005010X222A1

ST*837*0001*005010X222A1

BHT*0019*00*11AAAA*20250923*1237*CH

NM1*41*2*LYTEC TUTORIAL*****46*GBA

PER*IC*CONNIE ROMANO*TE*2812108987

NM1*40*2*EMEDIX CLAIMS*****46*PAYERID

HL*1*1*20*1

NM1*85*2*CENTERTOWN OFFICES*****XX*1234567890

N3*123 PROFESSIONAL AVENUE*SUITE 146

N4*SALT LAKE CITY*UT*84124

REF*EI*75123456

PER*IC*DANNY LITTLE*TE*6035551111

HL*1*1*22*1

SBR*S*18***12****MB

NM1*IL*1*ADAMS*GEORGE*F***MI*8D3B2452AE12D

N3*987 FERRIS STEET

N4*MADISON*WI*93939

DMG*D8*17931212*M

NM1*PR*2*MEDICARE*****PI*PAYERID

N3*3889 FRANKLIN AVENUE

N4*MAIN STREET*WA*02543

CLM*1*47***11:B:1*Y*A*Y*I

REF*X4*45D3221112

HI*ABK:I10

NM1*82*1*LITTLE*DANNY****XX*9876543210

SBR*P*18*432742844376******CI

AMT*D*23

OI***Y*P**I

NM1*IL*1*ADAMS*GEORGE*F***MI*2588545428

N3*987 FERRIS STEET

N4*MADISON*WI*93939

NM1*PR*2*FIRST HEALTHCARE*****PI*32165

N3*123 INSURANCE DRIVE*SUITE 123

N4*MADISON*WI*01500

LX*1

SV1*HC:99213:::::OFFICE VISIT LEVEL 3*47*UN*1***1

DTP*472*D8*20250801

REF*6R*1

SVD*32165*23*HC:99213**1

CAS*CO*45*5

CAS*PR*2*19

DTP*573*D8*20250923

AMT*EAF*19

SE*9999*0001

GE*9999*1

IEA*9999*000000001

Alert
Troubleshooting Rejections

 1. 

Missing payer DOC control number.

 

We have been seeing a few payers requiring the primary payer control number or claim number.

To correct this go into the billing and click Billing > Bill options > Billing More information 2 and enter the Original Reference # number in which is your claim number or control number from the primary EOB.  Under the Resubmission # you would enter the number 1.

Info
PLEASE NOTE
1 means original claim and 7 is resubmission for a corrected claim.  Never put the 7 on the secondary as it is not a corrected claim but is an original claim.  You put the 1 so Lytec will send the control number.

2. COB invalid or out of balance. 
Few things to look at.  How you posted your payment, does it all add up in the billing?  If so, please call support so we can correct this for you. Another thing we found is that ICB or take-backs are causing it to fail at the clearinghouse level.