Submitting Secondary Insurance Claims Recorded Class
For customers in the United States, Sensei Cloud supports an unlimited number of patient insurance plans. Each patient can have one Primary, one Secondary, and multiple plans designated as Other. When the patient's treatment is covered by multiple active insurance policies on the date of service for the procedures being billed, you can submit claims to each one in order (P, S, then O) to receive the maximum possible benefits.
- A patient's associated insurance plans are visible from the Patient Snapshot, the Patient Home Page, and the Patient Record.
- When submitting claims for a set of charges, it is recommended that you submit to Primary insurance first and await a response, and then submit to Secondary.
- Only one claim can be open at one time for a particular set of charges.
- When a patient has multiple policies, the Cov column in the Claims Management screens display P for Primary, S for Secondary, or O for Other.
- For information about adding and updating a patient's insurance policies, see How to Add or Update Patient Insurance.
Important: For effective handling of secondary or subsequent claims, it is recommended that you update the New Claim Handling rule to Hold For Review instead of Auto Transmit, (Administration tab > Practice Settings > Claim Rules) to prevent queueing and transmission when the payer does not accept electronic attachments. For those claims, it is recommended that you print a copy of the claim and manually submit it to the payer, along with a copy of any required EOB(s) and supporting documentation.
To bill procedures to multiple insurance plans:
- From the Checkout Queue, select the patient and click Post Charges. The Post New Charges window is displayed with Bill Ins? selected for all procedures.
Note: If there are procedures that should not be billed to insurance at this time, you can deselect them here.
- In the Insurance to Bill field, the Primary plan is selected by default. It is recommended you bill Primary first, but you can select a different plan from this list.
Note: The plan billed first becomes Primary for this set of related claims.
Note: The selected policy must provide coverage for the types of services being billed, must not have been already billed for the services, and must have been active at the time of the Service Date.
- Click Post Charges & Bill Ins. A claim is created for the designated amount, and either sent automatically or receives a status of Pending Review, Needs Attachments, or Needs Info, depending on your Practice Settings and the details of the claim.
Note: If not sent automatically, continue to Patient > Insurance > Claims Management to prepare and submit the claim.
Note: Attachments or supporting information may be required. For more information, see How to Work with Orthodontic Claims and How to Add Attachments to an NEA FastAttach Claim.
- When the insurance company returns payment for the claim, finalize it by posting the payment (Patient > Ledger > New Payment). Important: You must select Payment Type: Insurance and then select the correct claim in the Claim Number field, so that the next claim created for these charges can be properly processed. The Perform Next Steps - Claim window is displayed.
Note: When the patient has no remaining coverage to bill and/or all of the expected reimbursement has been received, click Post Write-Off to resolve the remaining portion of the unpaid balance. It is recommended that you wait until all submitted claims have been adjudicated, so that the lowest acceptable write-off can be posted.
- Select Bill Next Insurance. The Bill Next Insurance window is displayed, with all the procedures from the original claim selected by default.
- If necessary, deselect any procedures that do not belong on this claim (i.e., secondary insurance does not cover certain procedure types or primary claim has paid certain charges in full).
- The Insurance to Bill field defaults to the next plan in the list (Secondary if Primary was finalized, Other if Secondary was finalized), but you can select a different plan to bill if needed.
Note: If a claim was already settled for these charges, that plan is not available in the list.
- Click Create Claim. The claim is created and added to the patient's Claims Management screen.
Important: Secondary claims require the inclusion of the EOB from the previous payer. When processing and submitting secondary or tertiary claims, you are prompted to include EOB and/or other attachments. Use the Claim Summary controls to prepare and submit the claim.
Note: For more information, see How to Add Attachments to an NEA FastAttach Claim.
- For subsequent insurance policies, repeat steps 4-8.
Note: This procedure describes the recommended, most direct workflow for billing charges. Sensei Cloud provides you with the flexibility to manually post charges and create new claims as needed for previously posted, unbilled charges, and so forth.