This EDI rejection occurs when the claim is going out as a secondary claim to the payer and the information from primary insurance was not submitted on the claim. There are a couple of general scenarios.
- You do not have a primary insurance card entered for the patient in Therabill. If this is the case, then there will be no information on your claim about the patient's primary insurance plan.
- You have entered a primary insurance card, but you did not enter the primary insurance payments on the sessions in Therabill prior to submitting the secondary claim. You will need to first enter the payments that you received from Primary and then submit the claim.
- A secondary claim submission when the sum of the payment amounts, adjustments, and patient responsibility that you entered from their primary insurance does not equal the charge amount.
What makes it go out as a secondary claim from Therabill?
If the responsibility on the insurance card in Therabill is not set to Primary (i.e. it is set to Secondary or higher), then the claim will go out as a secondary (or higher) claim.
How do I enter payments from secondary to go out on the claim.
If you are receiving ERA, then you can post them directly from the ERA. If you are not receiving ERA, then you will want to post them manually using the Insurance Payments w/ COB option. For a short instructional video on entering primary insurance payments (with COB), please see: Entering Insurance Payments with Coordination of Benefts in Therabill.