Cob second insurance

nbraper

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Hi everyone!!
please advise. I was informed by my office manager that I am required to bill the patient's second insurance with no adjustments from the primary patient's insurance.
I have always posted the payment and if there was no balance due (they paid 100% of contractual allowed amount) I would adjust per their requirement and not bill the second insurance
because no additional payment (coinsurance/copay/deductible, etc) was due. Is it legal to bill the second insurance without adjustments from the primary insurance?
I am required to bill the second insurance with a $0.00 balance due. please advise!!!!!!!

Thanks!!
Nina
 

CodingKing

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I'd still send the claim with the primary EOB to the secondary carrier. It will depend on the contract with the secondary. Most will just say no additional payment due since the primary paid more than they would have allowed. Some will make up the difference if there is a higher contract rate. Another reason is patient may have a deductible on the secondary and that amount may help them satisfy the deductible in case of any future claims. The secondary carrier will also want to keep track of COB savings. There are various other reasons as well. I believe you report the amount paid in box 29 and the write off amount as amount due in box 30.
 
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Retrophaze

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Largo, FL
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In my office, our programs won't even create a bill for a secondary insurance company if the primary paid in full. I've never heard of billing a zero bill typically because secondary won't pay higher than the primary. Plus, we do not balance bill.
 

CodingKing

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In my office, our programs won't even create a bill for a secondary insurance company if the primary paid in full. I've never heard of billing a zero bill typically because secondary won't pay higher than the primary. Plus, we do not balance bill.

With the huge switch to Qualified High Deductible plans, i think things need to be handled differently than in the past. I guess one could only do it when asked for by a patient. I'd sure want the deductible credit for later. Then again things like routine with no cost share there would be no reason to bill a secondary.
 

ljones88

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Stuart, Florida
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In our practice, we post the payment and the adjustment from the primary insurance as we are contractually obligated to do (since we are under contract with that insurance). If no balance exists after the CO-45 than the claim isn't filed to the secondary.

I'm not sure why one wouldn't take the adjustment because when the claim is filed to the secondary, with the primary EOB, the secondary payer is going to see the primary allowable, the payment from the primary payer, any patient responsibility, and the contractual adjustment. If that results in a zero balance after the primary payment, secondary shouldn't pay anything anyways.

I have seen where the secondary doesn't coordinate benefits with the primary payers, they go by their own fee schedule with us, and pay their allowable. Sometimes this results in a credit back to the insurance company. We run reports each month to refund patients or payers any overpayments.

We also have instances where the patient paid a copay at the time of service. Primary applied the copay, resulting in a zero balance, but because the patient has a responsibility, the claim is filed to the secondary, where they pick up that copay. The credit is then refunded to the patient.
 
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