What this button does

After the primary payer pays, Generate Secondary Claim retargets the claim at the patient's secondary payer. It does not create a new claim. It points the same claim at the next policy and includes the primary payer's payment and adjustments as coordination of benefits, then adds the claim to your next transmission batch.

Before you start: The button only appears when the claim lists a secondary payer and the primary payer's payment is already posted, either as an EOB or as an insurance payment on the ledger. If you do not see it, check the claim's payers and post the primary payment first.

Post the primary EOB with line detail first

Some payers, especially Medicaid plans, reject a secondary claim that only carries a claim-level total from the primary. Before generating the secondary claim, post the primary payment through Post EOB so each service line carries its own paid amount and adjustment codes. A lump-sum Post Entry payment works, but the line-level version gets rejected less.

How to generate a secondary claim

  1. Click AR in the menu and open the claim's AR detail page.
  2. In the Transactions section, click Generate Secondary Claim.
  3. A confirmation window names the secondary payer and explains that the primary's payment and adjustments will be included as coordination of benefits. Click Confirm.

Then get it to the payer

Confirming queues the claim for your next submission batch. If your claims transmit to your clearinghouse automatically, the secondary claim goes out on the next run and you are done. If your agency downloads claim files and delivers them yourself, you still need to do that step: pull the new claim file from the EDI Exports page and upload it to your clearinghouse, or print a CMS-1500 if the secondary payer takes paper. The secondary claim is not sent until one of those happens.

Example

Medicare paid $328.40 on a $1,200 transport and the patient has a Medicaid secondary. You posted the Medicare EOB line by line with Post EOB, so the claim carries the paid amounts and adjustment codes per line. You click Generate Secondary Claim, confirm, and the claim is queued for Medicaid with the Medicare payment attached. On the next transmission it goes out, and Medicaid can see exactly what Medicare paid on each line.

Tips

  • Check the payer order on the claim before you generate. The button targets the payer marked secondary, so a wrong order sends the claim to the wrong place.
  • Log a touch in the AR Log when you generate a secondary claim so the next biller knows where the claim stands.