HOW TO BILL SECONDARY/TERTIARY CLAIMS

You are trying to bill all or some of your secondary carriers but you are not getting all the bills that you though you should.

To bill a patient's Secondary Carrier you need to remember 3 things.

1. Go to Claims, Visit Info./Misc. and be sure that "Bill to Secondary" is checked to show that you do indeed want to create a HCFA for the secondary carrier..

2. Be sure the Primary Carrier has already been billed.

Finally and MOST important:

3. The Secondary Carrier must not have already been billed.

To check to see if there has been a secondary billing run for a date of service, open a patient’s ledger. Now open the Financial Transaction Browser (ALT F8). This brings up a screen showing “hidden” data. Click once on the line of service in which you wish to check the billing. Look in the detail area at the bottom of the screen. For this service, you will see a button [BILL INFO]. Click on this button. You will all dates (if any) of bills which include this service date. It will look something like the following screen:

In the first line above, you see a value in the CAR_NUM field. This means that this was a carrier bill batch. The second line above shows a “null” or No Value in the CAR_NUM field. This means that this was a Patient Bill batch.

You could also have the same problem with secondary billing that you have with the primary billing. If the billing parameters setup for the secondary billing are too restrictive, TPS! may not find the secondary billing. Remember, just like in billing a primary, if you have changed the secondary carrier you will need to do either an ALL CARRIER secondary billing, or a SELECTED CARRIER secondary billing, tagging both the original carrier in the secondary slot and the one that is there currently.

To open the Billing area, choose Billing (Carrier & Patient).

You will use this section of TPS2000 to create HCFA forms to bill your Carriers and Patient Statements to send to your patients.

ADD A NEW CARRIER BILL BATCH

To start a new bill run, click on the [+] icon on your Navigation Bar. You will see the message “Do you want to start a new bill run?”. If you answer YES it will create a blank screen ready for you to enter data. Under Bill Type – choose the type of bill batch

REGULAR BILL - Used for normal Carrier bills and Patient Statements

You may, at any time, reprint an existing bill in the TPS 2000 program. It doesn't matter if this bill is completely unpaid, partially paid or entirely paid. It is possible to reprint it from the original batch. However, it may not be convenient or efficient to reprint original bills under some circumstances, TPS 2000 has the ability to automatically track and then create on demand Tracers and Rebills

Next choose Bill To –

CARRIER AND ATTORNEY BILLS -- if you select this entry, it will create carrier and/or attorney bills in the format setup in the carrier and/or attorney entries.

Level – If this is a Carrier and/or Attorney bill run, choose the billing level –

SECONDARY - Secondary means second. This usually refers to backup or additional insurance for your patient. For Example, Mrs. Brown has Aetna insurance through her office, this would be primary. Mr. Brown has Blue Cross insurance through his office, and Mrs. Brown is additionally covered by this policy as well as her own. Blue Cross would be Mrs. Brown’s secondary.

NOTE: A primary bill must have been created and posted before services will be eligible to be processed as a secondary bill run.

TERTIARY - Tertiary means third. This seems to be seldom used. There would be a couple of common scenarios: First - Bob Brown is a 17 year old box boy at the local grocery store. He is covered by Retail Clerks insurance through his work and this is his primary. Bob is also covered by his Father’s Blue Cross Insurance, this would be Bob’s Secondary. In addition, Bob is covered by his mother’s Aetna policy, this would be his Tertiary coverage. Second – Your patient has an automobile accident. This patient is covered by a MedPay policy, this would be the primary. This patient also has medical insurance through their work, this would be the secondary. Finally, your patient was not the party at fault, so the Tertiary coverage would be the at fault person’s insurance.

NOTE: A primary and a secondary bill must have been created and posted before services will be eligible to be processed as a tertiary bill run.

Bill Date will default to Today’s Date, this may be changed if you wish, by clicking on the small calendar to the right of the date entry.

Minimum Bill Amount – This is the smallest amount due for which a Carrier Bill will be processed. NOTE: Do not make this amount greater than the smallest services and/or inventory item provided. I.e. if you sell an ice pack for $3.00, do not make the minimum bill due greater than $3.00 or there is a chance that this item may never be billed.

Maximum Bill Amount – This is the largest amount that you want to see on a bill run for an individual patient. There are some states, or even specific insurance companies that don’t want to see a bill larger than $300.00. Anything over this amount goes to a supervisor and may delay your payment. TPS 2000 allows you to control how much is billed in a single bill run.

Start Date -- This date defaults to a date one month ago, however, it may be changed if you wish, by clicking on the small calendar to the right of the date entry. NOTE: unless you are processing a Rebill or Tracer batch, it is best to remove this date. In this manner TPS will find all services that are capable of being billed and have not yet been billed.

End Date -- This date defaults to yesterday’s date, however, it may be changed if you wish, by clicking on the small calendar to the right of the date entry.

Once you have filled in the above settings click on CREATE BILLS…

You will now be on the selection screen for carrier billing. From here you may select all or only some doctors for billing.

Next, decide if you will be billing ALL CARRIERS, SELECTED CARRIERS, CARRIERS BY TYPE or only certain patients FOR SELECTED CARRIERS.

CARRIER BY TYPE

Click on the Select Carrier by Type Tab. Choose the carrier type(s) for whom you are processing bills.

ALL OR SELECTED CARRIERS

Click on the Select Carrier Tab. Choose ALL or the individual carriers for whom you are processing bills.

PATIENTS FOR SELECTED CARRIERS

Click on the Select Carrier Tab. Choose the individual carriers for whom you are processing bills. Then click on Select Patients Tab. This will display a list of patients that have the carrier(s) you selected in their file. Click on ALL or the individual patients for whom you are processing bills.

At the bottom of your screen is a button titled CREATE BILLS. Click on this button when you have made the above selections.

Once the bills display the column on the left is the PRINT selector. If there is an arrow in this column the bill is set to print. You may control which bills print (including all) by clicking on the individual bills or using the Print Selection buttons at the bottom of the screen.