Once a primary claim has been generated, secondary claims can be generated whether an electronic payment or paper EOB has been received.

To create a secondary claim with an ERA:

1. Navigate to the Claims module and select Claims Manager
2. Click Actions next to the claim and then Generate Secondary Claim
3. In the claims editor, click COB and then the Adjudication tab, which displays the primary claim ID the secondary claim was generated from
4. Review the fields in the “Adjudication” tab, which include but are not limited to:
   
   • “Service line adjudication and adjustments”, if different from the ERA received. 
     • Please note:
       • If multiple payments have been received, information based on the most recent non-negative payment will pre-populate
       • When editing “Charges” and “Amount paid”, all lines are now balanced in real-time to ensure the total charges are equal to the amount paid and adjustments. 
   • The “Policy Number” and “Group Name” fields in the “Payor” tab, which correlate to items 9a and 9d in CMS 1500 forms, respectively
   • The line entries for the services rendered. Change procedure codes or add additional information, if necessary
5. If any changes need to be made, click Modify
   • Select a reason in the Reason for modification* drop-down
   • If “Other” is selected, enter the Reason*
   • Click Continue
   • Please note, by default, organizations’ COB Payment Settings are set to require modification reasons. Admins can edit these settings to either “Optional” or “Not needed”
   • Click Save & Move to Inbox
6. To view any edits made to the “Adjudication” tab, click History and then Refresh
7. To submit the secondary claim, navigate to the Claims module and select Claims Manager
8. Click the Actions drop-down next to the claim and select Send to Gateway
   • Please refer to your state Medicaid office or payor for billing rules, such as combined claims
9. To monitor claims in the clearinghouse or secondary payor portal, log into your secondary payor portal and manage transactions as necessary.

To create a secondary claim without an ERA:

1. Navigate to the Claims module and select Claims Manager
2. Click Actions next to the claim and then Generate Secondary Claim
3. Click Continue in the “Generate secondary claim” pop-up to manually enter payment information
4. In the claims editor, click COB and complete the fields in the Adjudication tab, which include but are not limited to:
   • Add the “Adjudication date”, “Total amount paid”, and any adjustments under “Claim level adjudication and adjustments”
     • When editing “Charges” and “Amount paid”, all lines are now balanced in real-time to ensure the total charges are equal to the amount paid and adjustments. 
   • Ensure the “Policy Number” and “Group Name” fields in the “Payor” tab correlate to items 9a and 9d in CMS 1500 forms, respectively. 
   • Enter first and last names correctly and ensure the “Policy/Group/FECA Number” matches the primary insurance ID.
   • The line entries for the services rendered. Change procedure codes or add additional information, if necessary
5. Click Save & Move to Inbox
6. To view any edits made to the “Adjudication” tab, click History and then Refresh
7. To monitor claims, log into your secondary payor portal and manage transactions as necessary

Please note, changes will be saved and sent only with this claim. The original payment and billing entry will not be updated.

Click here to learn how to print a CMS-1500 form.