How to Create and Submit a Secondary Claim in Service Center

If you need to create a secondary claim in Service Center, follow the steps below.

Before You Begin:

Make sure the following tasks have been completed:

• The primary claim has been created and submitted.

• The Explanation of Benefits (EOB) from the primary payer has been received.

• Use the Payer List to confirm that the secondary payer accepts secondary claims.

Steps to Submit a Secondary Claim:

1. Locate or Create the Claim

• Go to the Claims section on the left-hand side of your screen and select Manage Claims.

• To edit an existing claim, click the View Claim eye icon.

• If starting from scratch, click Create Claim to enter the claim manually.

2. Convert to a Secondary Claim

• Click the Secondary Claim button at the top of the claim form.

• This action switches the claim type and reveals additional fields required for secondary billing.

3. Update the Payer

• Change the payer at the top of the form to the Secondary Payer.

• You can select from your stored payer list or search the Office Ally Payer List.

• If the secondary payer is not stored, it can be added from the list.

4. Verify Insurance and Patient Information

• Confirm all fields, including the Insurance ID and any other relevant patient or policy information.

• Ensure the claim reflects the secondary payer's details.

5. Update Box 9 (9, 9a, and 9d)

• Enter the Secondary Payer’s name, policyholder information, and other required details from the EOB.

Enter EOB Details from the Primary Payer:

Enter Key Line Item Fields

Use the EOB provided by the primary payer to complete the following fields for each line item:

• Allowed Amount – The maximum amount the primary payer allows for a service.

• Primary Payer Payment Amount – The actual payment made by the primary payer.

• Adjudication Date  

2. Enter Adjustments  

For each line item:

• Enter the Group Code, Amount, and Reason Code from the EOB.

• If multiple adjustments apply, click Add Line Item Adjustment to include them all.

• Make sure adjustments and payments match the original billed amount (Box 24F).

Example Breakdown:

Let’s walk through an example to help clarify the process.

Original Charge: $33

Amount to Be Written Off: $13 

Primary Payer’s Payment: $10 (with an adjudication date of 03/20)

Step-by-Step Instructions:

1. Enter the Primary Payment:

• Enter $10 as the payment from the primary payer.

2. Add Adjustments:

• $13 will be written off (this amount is typically a contractual adjustment).

• The remaining $10 will be marked as Patient Responsibility.

• For the $13 written off, use Group Code CO (Contractual Obligations) and Reason Code 45.

• For the $10 marked as Patient Responsibility, use Group Code PR (Patient Responsibility) and Reason Code 1 or 3. (depending on the situation)

3. Balance the Total Charge:
   Ensure that the total charge of $33 matches the sum of the primary payer's payment and any adjustments made.

Submit the Secondary Claim:

Once you've completed the secondary claim, make sure all line items are balanced, and there are no errors. If any errors are found, correct them before submitting the claim.

1. Submit the Claim  

• Once everything is filled out, click Send to submit the secondary claim for processing.

• If there are any missing details (like the primary payer), the system will prompt you to fix those errors before submitting.

Important Note:

Ensure all claim details and EOB values match the primary claim to avoid rejections or delays in processing.

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