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Do you need to obtain prior authorization from your secondary insurance even if the primary insurance will be billed first?
Wiki User
∙ 11y ago
Your secondary insurance has different PA criteria than your primary insurance. A PA means that your insurer will only cover a service under certain circumstances; company A may cover a service for 3 conditions and company B may only cover the same service for only 2 conditions. Your primary could pay and your secondary may not.
Wiki User
∙ 11y ago
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What is meant by primary and secondary insurance coverage?
Primary insurance coverage is what is first used when a medical service is being rendered. This is what will be billed first. Secondary insurance is supposed to cover what the primary insurance does not.
Difference between primary and Secondary commercial claims?
There is one major difference between these types of claims. When a person has two different insurance carriers, one of them is designated as the primary coverage and the other as the secondary. The primary insurance should be billed first and normally pays the bulk of the bill. The secondary insurance gets billed for the remainder of the bill which the primary insurance did not pay for.
If the primary insurance allows more than the secondary insurance what would the secondary insurance pay?
Secondary insurance will not pay the claim but the remaining charges should not be billed to the member/patient. Provider of service should write off the patient responsibility that primary insurance applied.
What is a Payer of Last resort?
A payer of last resort is an entity that pays after any other primary programs have been billed. For instance, after a primary insurance company, a secondary or even tertiary program can come in and pay the last of a bill. In some cases, the patient can no longer be billed for services after this payer has paid or denied payment.
When a secondary health insurance plan does not cover the remaining balance is it the patient responsible?
Gererally speaking, the answer is Yes, after checking to make sure that the claim was billed using the correct diagnosis and codes.
Will you bill my insurance company?
Yes, definitely your insurance company must be billed for all its expenses.
How do you process superbills?
The way a superbill is processed depends on what type of insurance the patient has. For example, if a patient has Medicare or Medicaid, the claim is billed electronically via a computer software that is sometimes referred to as a claims clearinghouse. There are many other insurances that require that all charges be submitted electronically. If you are billing an insurance company that accepts paper claims, you simply ensure that the claim is completed correctly and mail it to the claims address that is specified by the insurance company. If you are billing a secondary insurance payor, you have to make sure that a copy of the remittance that shows how much the primary insurance paid is attached.
What if you are a us citizen and are hurt in Canada?
you will be treated in a hospital, then your insurance will pay the costs, if you do not have insurance, you will be billed accordingly.
What is the importance to the practice regarding the 80 20 payment scheme?
Medicare is paying only 80% of the approved amount the patient is being billed. The responsibility for 20% of the Medicare approved amount will be transferred to the secondary insurance carrier.
If a married couple have medical insurance through each one's employer who's insurance pays the doctor bills first?
I have been a medical biller for over 10 years. It is always whoever is going to the doctor that one's insurance will pay. So, the husband goes to the doctor it is his insurance that would be the primary insurance and the wife's insurance could then be billed for the balance, i.e. copay, deductible, etc.
How much is a Spinal-Stim bone growth stimulator cost?
OL1000 hcpcs code E0747 = $4200.00 AND SPINALOGIC hcpcs code E0748 = $5250.00 billed to Medicare Part B and Secondary Insurance on 10-27-11.
How much does a cholesterol test cost?
my mom said her insurance was billed for $455
