Before creating a secondary claim, you must wait to until the primary claim has been processed and then accurately record the amount paid toward the service directly on the invoice.
NOTE: Some secondary payers (ex. Medicare) require additional reasoning codes be applied to all secondary claims. CounSol.com is currently unable to add these specific codes to the claim forms. In these cases, you must log in to your Office Ally account and create the claim manually from within Office Ally's system.
CREATE A SECONDARY CLAIM from the primary ERA (when an ERA is present)
1. Open the ERA delivered from the Primary claim filing.
2. Enter the transactions and/or mark the ERA as Complete.
3. On that same View ERA page for the claim sent to the primary carrier, scroll to the bottom and click the Create a Secondary Claim button. The claim will generate fully populated with all the information from the primary filing.
4. Confirm the info displayed is accurate, then click Save Complete to change the status to Ready for submission.
CREATE A SECONDARY CLAIM from the primary CLAIM (when no ERA is present)
Note: Any payments made by the client or the primary insurance should be posted to the invoice BEFORE creating the secondary claim. For a claim to be tied to a specific client and session, and the claim should be made directly from the primary claim.
1. Open the already filed primary claim for the session where a secondary claim is required.
2. Click the Create Claim for Secondary Payer link located near the top of the page next to the Claim Number.
3. Reference the primary claim filing results to manually enter the Charges, Amount Paid, and $ Amount of any claim adjustments in the blue highlighted Item 1 Prior Claim Adjudication and Adjustments area.
Note: Section 35 on the secondary claim asks for the same information as the area described above. In most cases, Section 35 should be left blank.
4. When ready, click Save Complete to change the status to Ready for submission.
Note: Electronic: Once an electronic claim has been saved as complete, the status will show as Ready. All claims with a Ready status will automatically be sent to the clearinghouse.
Paper: Once you are ready to print a paper claim, make sure to place the red 1500 form in the printer and not a blank sheet of paper. Printing does not print the form itself. The fields are pre-formatted to print the information you provide directly onto the red form. If the fields are not aligned when printing, see the 1500 Form Printing page.
To read the 1500 Health Insurance Claim Form Reference Instruction Manual Click Here
