Electronic Secondary Insurance Claims
SOAPware has completed the second phase of the Auto Remit Posting feature with an added option to generate a secondary electronic claim. Although many claims are forwarded to the secondary payer automatically by the primary payer or Trizetto/Gateway EDI, users now have the option to create and upload an electronic secondary claim which will include primary payment information for some of the claims your practice is currently printing, attaching a paper EOB and mailing to secondary payers. Payers that have Electronic COB availability can be verified by checking your payer list on Trizetto's website.
Set Default Preference
Select default preference for secondary claims at Tools->Insurance Companies. All existing payers will continue to default to paper unless the Route is changed to Electronic. The selection here will define the default route for secondary claims in New Charges tab, Claims tab, Create Claim from Ledger tab and Insurance Payment Posting. Check Electronic EOB availability on your Payer list at Trizetto Provider Solutions.
New Secondary Route Default
Collapsed Claim Details section in Insurance Payment Posting will display as the Default option selected in Insurance Company setup, but can be changed if needed. When Paper is selected, the Next Action will default to File Secondary-Paper and if Electronic is selected, it will be File Secondary-Electronic.
Enter Primary Payment Information
Insurance Payment posting now has additional payment and adjustment sections that are required in order to report primary payment information to the secondary payer. This information will be automatically populated when the final phase of Auto Remit Posting is completed, but can be manually added at this time if needed. If this information is included on a remit, it will be required in the secondary claim file.
Note: This information can be left blank unless a secondary electronic claim has to be created within SOAPware. If Trizetto/Gateway normally submits your secondary claims or if the secondary is a Crossover claim, you will not need to enter the additional information.
Patient Responsibility (PR) Adjustment Codes
The Deduct, CoIns and Co Pay amounts will automatically populate the Adjustment Codes grid when manually added to those columns. Since these amounts are the patient responsibility group, they will not be calculated into the Adjustment Totals.
- PR-1 Deductible
- PR-2 Co-Insurance
- PR-3 Co-Pay
Contractual Adjustments must be manually completed in the Adjustment Codes grid at this time.