How do you process a secondary claim?
Asked by: Alize Macejkovic | Last update: September 15, 2025Score: 4.5/5 (20 votes)
How do secondary claims work?
You can file a secondary claim to get more disability benefits for a new disability that's linked to a service-connected disability you already have. Here are some examples of when you might file a secondary claim: You develop arthritis that's caused by a service-connected knee injury you got while on active duty.
Do I need a diagnosis for a secondary claim?
Steps to File a Secondary Service Connection Claim
Obtain a Medical Diagnosis for the Secondary Condition The first step is to get a clear diagnosis for the secondary condition you are experiencing. This diagnosis must come from a licensed healthcare provider and be well-documented in your medical records.
How does secondary insurance billing work?
Secondary insurance pays after your primary insurance. Usually, secondary insurance pays some or all of the costs left after the primary insurer has paid (e.g., deductibles, copayments, coinsurances).
Who sends secondary insurance claims?
Healthcare practices cannot submit a claim to both insurance companies at the same time. Instead, you'll need to submit to the primary insurance, wait to see how much the primary insurance will pay, and then submit to secondary insurance.
How to File a VA Claim for Secondary Service Connection
How to submit secondary claims?
After the primary insurance processes the claim, note the allowable amount, the patient responsibility and any adjustments. Submit the claim to the secondary insurance. Make sure to include the original claim amount, how much the primary insurance paid and reasons why they didn't pay the entire claim.
When dealing with secondary claims, when do you make your insurance adjustments?
Wait until BOTH insurances have paid in order to make the adjustment. Properly knowing how to handle dual insurance will save you time and hardship in the future. It all starts with insurance verification!
Can a provider refuse to bill secondary insurance?
A: The answers to your questions depend on state law. Some states require physicians to bill all insurers a patient has, without charge, whereas others do not. If the physician has a contract with the secondary insurer, then, by contract, he or she most likely is obligated to submit the bill.
What is the primary secondary insurance rule?
The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.
Can you file a claim with two insurance companies?
An example of this would be filing a claim with one insurance company for damages to your car and a different claim to another insurance company to cover medical bills and lost wages. Double dipping is illegal and can have some serious negative consequences.
What are examples of secondary conditions?
Some of the more common secondary conditions include depression, hypertension, chronic pain, skin sores, fractures, contractures, urinary tract infections, respiratory infections, unwanted weight gain, excessive fatigue, and social isolation (Simeonsson & McDevitt, 1999).
Do I need a Nexus letter for a secondary claim?
Veterans pursuing VA disability claims often face complex regulations and procedures. A crucial component to bolster your claim for secondary conditions is a well-crafted nexus letter. This document connects your primary service-connected disability to a secondary condition, serving as essential evidence.
What are examples of secondary diagnosis?
A secondary diagnosis is any condition that coexists with the primary condition at the time of a patient's admission. For instance, if a patient is admitted with a primary diagnosis of heart failure and also has diabetes, diabetes would be considered a secondary diagnosis.
What is the timely filing for secondary claims?
Answer: The timely filing requirement for primary or secondary claims is one calendar year (12 months) from the date of service. Providers should follow up with primary insurers if there is a delay in processing that may result in going past the Medicare timely filing limit.
Do you need a diagnosis for a secondary condition?
The secondary condition must be medically diagnosed by a healthcare professional. There must be clear medical evidence showing a relationship between the primary service-connected disability and the secondary condition.
When submitting a claim to secondary insurance what should be attached from the primary insurance?
Secondary payers require specific information on secondary claims to determine how a primary claim was processed. This information is listed on the primary claim's Payment Report, Explanation of Benefits (EOB), or Electronic Remittance Advice (ERA).
How do you handle secondary insurance?
The Billing Process for Secondary Insurance Claims
Submit Primary Claim: The first step in billing secondary insurance is to submit a claim to the primary insurance carrier. Once the primary claim is processed and any applicable payments or denials are received, you can proceed with billing the secondary insurance.
What is the birthday rule?
The rule requires that the parent whose birthday comes first in the calendar year would cover the cost of delivering the new baby regardless of whether one parent has better health coverage for a newborn than the other.
Will secondary pay if primary denies?
It depends on which insurance is considered “primary” and which is “secondary.” The insurance that pays first (primary payer) pays up to the limits of its coverage. The insurance that pays second (secondary payer) only pays if there are costs the primary insurance didn't cover.
Who pays for secondary insurance?
The "primary payer" pays up to the limits of its coverage, then sends the rest of the balance to the "secondary payer." If the “secondary payer” doesn't cover the remaining balance, you may be responsible for the rest of the costs.
What is the No Surprises Act?
The No Surprises Act protects consumers who get coverage through their employer (including a federal, state, or local government), through the Health Insurance Marketplace® or directly through an individual health plan, beginning January 2022, these rules will: Ban surprise billing for emergency services.
Will secondary insurance pay if primary deductible is not met?
Double coverage often means you're paying for redundant coverage. first. The other plan can pick up the tab for anything not covered, but it won't pay anything toward the primary plan's deductible. If both plans have deductibles, you'll have to pay both before coverage kicks in.
Can you have two insurance claims at the same time?
While you cannot file multiple claims against the same party or provider, you can file multiple suits after an auto accident if multiple parties were at fault or if multiple insurance companies maintain coverage or may be responsible, and you suffered injuries or damages as a result.
What does value code 47 mean?
47. Any liability insurance (Payer Code L) Portion of a higher priority liability insurance payment made on behalf of a Medicare beneficiary that the provider is applying to Medicare charges on the bill.
What is the birthday rule for insurance spouse?
If your birthday is earlier in the calendar than your spouse's, then you'll likely be the primary health insurance provider for the dependents. If you and your partner are legally separated or divorced and not remarried, then the one with primary custody of the children provides primary healthcare coverage.