Secondary & Tertiary

Features Supported

• Initial submission to secondary and/or tertiary payers upon prior payer’s decision being posted (if not auto-forwarded by prior payer) electronically with prior payer’s remittance information encoded in the claim submission file or through paper (only if payer does not accept electronic submissions) with the prior payer’s physical EOB

• Reconciliation and posting of secondary and/or tertiary payer’s decision for all claims even if claim is auto-forwarded by prior payer

• Denials and rejections reviewed and worked for all claims (even auto-forwarded claims)

Features Not Supported

• Submitting a claim with the prior payer’s actual EOB file electronically

• Submitting to secondary or tertiary if there’s no patient responsibility adjustments in the prior payer’s remittance

• Skipping submission to secondary and/or tertiary and moving to next payer

Speciality Claims (Worker’s Comp, Auto, Legal, etc.)

Features Supported

• Electronic, email, fax, and paper mail claim submissions

• Attaching medical documentation with claim submission

• Reconciliation and posting of WC payer’s decision

• Sending an Invoice instead of a claim

Institutional (UB-04)

Features Supported

• Electronic and paper mail claim submissions

• Reconciliation and posting of Instiutional payer’s payment