Expert: Tricia - 10/2/2008

Question
We have ADS softwear in our office and I was wondering how do you submit a copay to the secondary insurance. We do not have a cpt code for this that i am aware of, or is there one. When claims are sent electronically the softwear vendor submits to primary and secondary. If the copay is to be paid by secondary, is it automatic as long as the copay was not paid by the patient? We usually print out a bill and have the patient submit the copay to the secondary insurance after they have paid it to us. Any educational advice on this is greatly appreciated.

Answer
Hi Blanche!

I do not know this software--there are hundreds of billing software types and I don't know them all.

However when billing for a secondary you bill on a 1500 form the balance due if there is no fee schedule or contract adjustment.  Usually the provider bills the secondary prior to billing the patient as the insurance companies usually pay the provider not the patient.  

I am not aware that when billing electronically the software vendor bills both primary and secondary.....we use Emedeon which use to be WEBMD and they only bill the primary....if our patient has a secondary then we have to rebill electronically ourselves.

Medicare is the only company that bills the secondary via their Medigap program.

Good Luck!
Tricia