Question Zero Balances after Primary

aosborne88

Contributor
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10
Location
Glendale, AZ
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If the patient's primary insurance states that the patient has no copay, deductible or coinsurance, leaving a $0.00 balance after payment and contractual adjustment and sequestration, do you still have to send the claim to secondary with the primary EOB? Or is this not necessary?

**Sometimes Medicare crosses over for you but I am wondering for other payers.**
 

csperoni

True Blue
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1,222
Location
Selden
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If you are contracted with the secondary, it's highly likely somewhere in that contract it states you are required to bill them (unless patient opts out).
My recommendation would be to send 1 bill with the EOB, but since there's no balance, there's nothing to follow up or track.
Here's an example of a real world situation why it would be a best practice:
My employer gives us credits in premium savings if we perform certain screening exams (mammo, PAP, dental cleaning, etc.) I only get the credit if the insurance receives the bill, even if they don't have any financial responsibility and are not paying.
 
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I agree with csperoni. It's especially important if the patient has Medicaid or Medicaid secondary since they track patients care gaps.
Here is example from my practice: If the patient's secondary insurance keeps up with care gaps via claim information submitted then a claim is the only way the insurance will get notified that the patient has closed the gap. I have even had a insurance company call me before after they reached out to a patient to see why they had not had a wellness exam. The patient did have a wellness exam and the primary insurance had paid 100% so we didn't file the secondary. The secondary insurance told us that we still needed to file a claim even if the primary pays 100%.
 
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