Wiki Secondary Billing

[StephanieKoehn]

I have a group of providers working in a virtual practice that are submitting claims under the virtual billing NPI to payers for the primary payment. The question is can these same providers submit claims to the secondary payer using their individual billing NPI, using the COB from the payment received billed by virtual billing NPI? This would result in the primary claim being paid to one practice while the secondary claim is being paid to a different practice, all for the same patient/same service/same rendering provider/different billing provider. Questions and insights encouraged.

 

[Mayzoo]

The secondary is only supposed to pay for what the primary did not pay. to receive payment you would need to send the same bill you sent to the primary and the EOB from the primary to the secondary. I do not believe billing them the way you spoke of (if I understood correctly) is ethical nor would it likely net any payment. They know they are secondary and would require the primary EOB to process payment.

But I am still new at this, so hopefully a more seasoned person will come along.

 

[StephanieKoehn]

The secondary is only supposed to pay for what the primary did not pay. to receive payment you would need to send the same bill you sent to the primary and the EOB from the primary to the secondary. I do not believe billing them the way you spoke of (if I understood correctly) is ethical nor would it likely net any payment. They know they are secondary and would require the primary EOB to process payment.

But I am still new at this, so hopefully a more seasoned person will come along.

Mayzoo - I agree with you. This is a bit of a fact finding mission. All of my training tells me that the primary and secondary claims must mirror each other and both claims should come from the same entity and be paid to the same entity. I have been challenged to see if what I have described above is a possibility. Thanks for your reply!

 

[SharonCollachi]

This would result in the primary claim being paid to one practice while the secondary claim is being paid to a different practice, all for the same patient/same service/same rendering provider/different billing provider. Questions and insights encouraged.

That's gonna fly like a lead balloon. The secondary claim would (and should) be denied because there is no primary claim from that provider for that date of service. There are secondaries who will pay even if you're not in the network, although not all of them do. You should be telling your patients before they receive services if you are not in network with their secondaries, and how much you think they will be responsible for.

 

[vanessamoldovan]

I have a group of providers working in a virtual practice that are submitting claims under the virtual billing NPI to payers for the primary payment. The question is can these same providers submit claims to the secondary payer using their individual billing NPI, using the COB from the payment received billed by virtual billing NPI? This would result in the primary claim being paid to one practice while the secondary claim is being paid to a different practice, all for the same patient/same service/same rendering provider/different billing provider. Questions and insights encouraged.

A claim billed to a secondary payer will only be processed/considered for payment if the information on the secondary claim matches the information on the primary EOB. That would include the NPIs.