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Secondary Claims

When a client carries two coverages, the secondary payer wants to know what the primary did before it pays its share. Secondary claims package exactly that — the primary's payment and adjustments ride along as coordination-of-benefits data.

Before You Start​

The client needs a Secondary coverage on file (added like any coverage on their Payment & Insurance tab, with Type = Secondary). File and finish the primary claim first — a secondary claim filed before the primary adjudicates will bounce.

Creating a Secondary Claim​

  1. Open the primary claim's detail page. Once the client has secondary coverage and the claim has progressed (accepted, paid, denied, or applied to deductible), a Create Secondary Claim button appears.
  2. The modal shows the secondary payer and member ID, then two sections that mirror what the secondary payer needs:
    • Box 8: Other Payer COB — what the primary paid, the remaining patient responsibility, the primary's claim control number, and the adjudication date.
    • Box 24: Service Line Adjustments — per-line "Paid by Primary" amounts and adjustment codes (group/reason, e.g. CO-45).
  3. If the primary's ERA is already in the system, everything above fills itself — you'll see an "Auto-populated from ERA data" badge and can just review. No ERA yet? Enter the figures from the primary's EOB by hand.
  4. Click Create Claim.

The result is a draft secondary claim, linked to its primary, that you submit exactly like any other claim — electronically or externally. On the CMS-1500 it carries the other-insured details (Boxes 8, 9, and 11d "YES") automatically.

Tips​

  • Wait for the primary ERA when you can — auto-population beats hand-copying an EOB, and the numbers are the payer's own.
  • The secondary claim starts from the primary's services and diagnoses, so corrections belong on the primary first; recreate the secondary after fixing.
  • Track it on the Claims tab like any claim — same statuses, same fixing tools.