Note: Before submitting secondary claims, you must add a secondary insurance policy in the Insurance section of the client's Billing > Settings tab. You must also wait until a primary claim through Sessions Health has been approved or denied/rejected from the primary payer.
The process for submitting secondary claims is the same as submitting to primary insurance with some caveats. See our Manage insurance information article for directions on adding insurance.
To initiate a secondary insurance claim, click the Add Secondary button at the top of an eligible claim.
Add secondary insurance button
If your account is set up to receive ERAs for the primary insurance payer, the secondary claim will create with the necessary information needed to submit the claim.
If you manually entered the remittance for the primary claim, after creating the secondary claim, you'll see a message telling you to adjust the patient responsibility amount. This means that you need to add an adjustment reason code so the secondary payer understands why the primary payer didn't pay the amount being submitted. You must add any contractual obligation adjustments within the patient responsibility and write-off adjustment sections.
Adjustment Reason Code Needed
To add a reason code, to to the claims Details > Adjustments tab and click the Add button in the Patient Responsibility section.
Add Patient Responsibility Code
In the pop-up, add a Reason Code.
Note: If the primary claim is approved, the patient responsibility adjustment is almost always set with a reason code of:
1 - Deductible Amount,
2 - Coinsurance Amount, or
3 - Co-payment Amount.
If the primary claim is denied for being out-of-network, you'll oftentimes want to set the reason code to:
242 - Services not provided by network/primary care providers.
Note: If the primary claim is approved, the patient responsibility adjustment is almost always set with a reason code of 1 - Deductible Amount, 2 - Coinsurance Amount, or 3 - Co-payment Amount. If the primary claim is denied for being out-of-network, you'll oftentimes want to set the reason code to 242 - Services not provided by network/primary care providers.
Once the reason codes are added, click Save. You'll then be able to click Submit at the top of the claim.
Note: If the primary claim is approved, but the secondary payer requires changes to modifiers, you can adjust these prior to submitting the secondary claim. If you go to the claim details page and scroll to the bottom, you can click on the bill associated with the claim. From there, you can click on the three dots in the same row as the date of service and select Edit Services. This will then allow you to make changes to modifiers.
