How to Create and Submit Secondary Claims in Practice Mate

To submit a secondary claim in Practice Mate, follow the steps below. Please note, you must first create and submit the primary claim to the primary insurance before working on the secondary claim. You’ll also need to wait for the Explanation of Benefits (EOB) from the primary insurance.

Steps to Create and Submit a Secondary Claim:

Before you begin, make sure the patient's secondary insurance information is entered.  

To do this, scroll to the bottom of the Visit Details section and locate the secondary insurance area.  

Enter all required details, such as the subscriber ID and the patient's relationship to the subscriber (e.g., "self"), then click Update to save the information.

1. Create the Secondary Claim

• On the Visits tab, in the Patient Visit list, click the check mark next to the visit that you wish to create a secondary claim for.

• Hover over Select Actions in the top right and choose Create Secondary CMS 1500 02/12 Claims (New).

• You should receive a confirmation that the secondary claim has been created successfully.

2. Review the Secondary Claim

• Go to the Claims/Billing tab, locate the claim you just created.

• On the right side, you’ll see the Sec. Claim section highlighted with a "Y," indicating it's a secondary claim.

• Edit the claim to make sure the secondary information is correctly reflected. The primary insurance details should now appear in Box 9.

• In Box 9, 9a and 9d, update the information to reflect the details from the original primary claim.

3. Adjust the Claim Amounts

• Review the primary insurance’s Explanation of Benefits (EOB) to add the correct allowed amounts, primary payer amounts, and adjudication details.

• The total primary payer amount, plus any adjustments, must equal the total amount billed to the primary insurance for each line item.

• Ensure the secondary claim reflects any remaining patient responsibility and contractual adjustments.

• 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 04/01)

• Step-by-Step Instructions:

1. Enter the Primary Payment:

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

• Add Adjustments:

1. $13 will be written off (this amount is typically a contractual adjustment).

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

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

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

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

4. Finalize the Secondary Claim

• Continue adjusting the line items until everything is balanced correctly. Once all information is entered, the claim can be submitted by clicking on Update.

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 Notes:  

Ensure that all details match the primary claim’s EOB for accurate billing.

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