Secondary Workflow

SimplePractice has some really nice tools for submitting and tracking claims, but they are a bit lacking when it comes to managing secondary claims.

Here are a few tips to making it go smoother:

  • Write your secondary client’s last names in ALL CAPS so you can easily visually identify these clients in reminders and on reports

  • Set the client’s copay at $0

  • Add the client’s secondary insurance to their account AND include secondary insurance info on primary claim in the client’s Billing and Insurance settings:

 
 

  • When the primary EOB comes back, you will get a note in your reminders that there’s been an adjustment in the client’s account. The CAPS will tell you it’s a secondary client and it’s time to do the following steps:

  1. In the client’s account, identify the dates of service that were adjusted. If a copay/deductible has been added, change the fee back to $0 and delete the adjustment invoice. What this does is put the balance back on the insurance side where it belongs, until the secondary cliam is processed.

  2. Open the primary claim and click ‘Create secondary claim’. Be sure to adjust the modifiers as required by the secondary payer. NOTE: You will have to complete the secondary claim manually if you do not have ERAs set up — Here’s how.

  3. Submit the secondary claim.

  4. When the secondary claim is processed, charge the client according to the secondary EOB, if it indicates a Patient Responsibility.

Important: Be sure you are regularly running the Unpaid Insurance Report and tracking these items, which will be easy to do with the names in CAPS. Also, you can expect secondary claims to take more time than primary claims.

Kari Silverberg