Secondary Claims Workflow
How a session travels from the client's insurance setup, through the primary claim, into the Secondary Claims queue — and how to file and track the secondary claim from there.
Add the primary and secondary insurance on the client
Everything downstream keys off the client's insurance records. Each policy is a separate record with an explicit type — Primary or Secondary.
Open the client's file and go to the Insurance section of their profile.
Add the primary policy. Click Add insurance, set Insurance Type = Primary, and fill in:
Insurance payer (picked from the practice's payer list — the payer must carry a valid electronic payer ID)
Member ID and group number
Insured/subscriber details — name, date of birth, and the client's relationship to the insured (self, spouse, parent, other)
Optionally, front/back photos of the insurance card
Add the secondary policy the same way. Click Add insurance again and set Insurance Type = Secondary. This is the policy the system will bill after the primary has paid.
Make sure the client bills to insurance. The client's payment type must be Insurance so their sessions generate insurance invoices rather than self-pay ones.
Three fields make a secondary policy filable: the payer, the member ID, and the subscriber's date of birth. If any of these is missing, the claim will still surface in the Secondary Claims queue — but marked Blocked instead of Eligible, and the file button stays disabled until the policy is completed.
File the primary claim as usual
Nothing about this stage changes when a client has two policies. Claims always go to the primary payer first.
The session generates an invoice. After the appointment, it shows under Insurance → Unclaimed appointments.
Create the claim. The CMS-1500 is prefilled from the session, the client's Primary policy, the diagnosis codes, and the rendering provider. Review and submit — it goes to the primary payer electronically through the clearinghouse.
Wait for adjudication. The claim moves through Submitted → Accepted, then lands in a final status when the payer responds: Paid, Partially Paid, Denied, or Patient Responsibility (the payer applied the whole allowed amount to deductible/coinsurance/copay).
The ERA posts automatically. When the primary's electronic remittance (ERA/835) arrives, the system records what the payer paid, the contractual adjustments, and what it left as patient responsibility — line by line. This adjudication detail is exactly what gets forwarded to the secondary payer later.
When the claim appears in the Secondary Claims tab
The queue lives at Insurance → Secondary Claims. You never add claims to it manually — the system re-evaluates every invoice each time an ERA posts, and a claim enters the queue when all four conditions hold:
Each row carries a Readiness status telling you where the claim sits in its secondary journey:
By default the queue shows Eligible, Drafted, Filed, and Blocked rows — the ones that need a biller's attention. Use the Readiness filter to see the others. Each row also shows the primary payer and status, the primary ERA date, what the primary paid, and the outstanding balance, so you can work the queue without opening each claim.
Process the secondary claim from the queue
Click File as Secondary on an Eligible row. The system drafts the secondary claim for you: it clones the primary's CMS-1500 — same service lines, diagnosis codes, provider, and place of service — and swaps only the payer-side fields to the client's Secondary policy. The primary's adjudication is attached automatically.
Review the Coordination of Benefits (COB) summary. A review window opens showing exactly what will be forwarded from the primary's ERA:
Total charge, primary paid amount, and allowed amount
Patient responsibility split into deductible (PR-1), coinsurance (PR-2), and copay (PR-3)
Contractual write-offs (CO-45) and other adjustments
Line-by-line adjudication per CPT code, plus any warnings worth reading before you file
What you see in this summary is what the secondary payer receives.
The automatic COB check runs. The system verifies both policies in real time — that coverage is active with each payer and that they agree on who is primary and who is secondary. Warnings are advisory; only a hard mismatch (for example, the "secondary" payer reporting itself as primary) blocks submission, and you can re-run the check after fixing the policies.
Click Submit. The claim goes to the secondary payer electronically with the full COB detail embedded, so the payer can see what the primary paid and adjudicate the remainder. The confirmation message reflects the claim's real status — if the clearinghouse scrubs or rejects it, you'll see a warning instead of a false success.
Track it in the same queue. The row moves to Filed. When the secondary payer's ERA arrives, it posts automatically and the row flips to Adjudicated.
Close out the balance. Whatever the secondary leaves as patient responsibility becomes the client's balance to collect through normal client billing.
One claim per payer, linked together. The primary and secondary are separate claims with their own statuses and ERAs. The queue row links to the primary claim, and the secondary claim's detail page shows its own submission history — so you always have a full audit trail of both halves.