Secondary Claims

No matter where we go, what office we audit, secondary claims are treated more like a nuisance than the tremendous source of income they really are.

We audited one office only to find stacks and stacks of secondary claims hidden in different closets and stuffed in waste baskets. Sadly, these offices were further along in actually sending out secondary claims than most of the other offices we audit.

Secondary claims have the terrible reputation of bringing in only small amounts. Even if this were actually true…so? What in the world is wrong with small amounts? Absolutely nothing.

The crux of the billing process is to aggressively and tactfully collect from patients and medical insurance companies all the monies that are rightfully, legally and ethically owed the provider. Those who act as agents for healthcare providers do not have the right to decide which claims they will or will not pursue. Nor do they have the right to write off unpaid amounts or forgive a patient's debt. Only the healthcare provider can make those decisions.

Submitting secondary claims takes a lot of time and energy because the claim must also be accompanied by the primary insurance company's EOB (Explanation of Benefits). Medicare will often help the provider by sending the claim to the secondary insurance company after payment is made, but secondary companies complain that Medicare does not always do what they say. When that happens, the provider must resubmit the claim to the secondary company.

Fighting for secondary claim payment can often be far more time consuming than fighting for primary claim settlement. The difference is that secondary insurance companies cannot deny payment based upon the codes or modifiers used. They will, however, simply drag their feet, deny they ever received the claim, deny they received the EOB, deny Medicare sent the claim, plus a long list of other excuses. When this happens, we do not hesitate to send these medical insurance companies our various letters citing federal and state law regarding "prompt payment." When they still refuse to pay, we don't hesitate to file a complaint with state and federal insurance agencies.

Don't ever let anyone tell you that submitting secondary claims for payment is not worth fighting for because these claims just don't pay enough. Even the smallest payments will add up to large sums if you get enough of them. Taking the time and energy to collect all monies owed our clients has increased some incomes as much as 70%. Believe us when we tell you that it really is worth the fight.

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