Do you struggle with secondary insurance claims in AthenaHealth? Are denials affecting your practice revenue a lot? Studies show 30% of patients have secondary insurance coverage. Secondary claims account for 25% of all billing errors. Practices lose $5,000 monthly on secondary claim mistakes. Proper handling can increase revenue by 15% annually. AthenaHealth offers tools to streamline secondary insurance processing.
Secondary insurance processing needs careful coordination and attention. Primary insurance must pay first before secondary billing. AthenaHealth automates much of the secondary claims process. Revenue cycle management with secondary payers needs special workflows. Understanding coordination of benefits saves time and money. Secondary insurance claim denials and fixes follow specific patterns. Most denials happen due to coordination of benefits errors.
This guide shows best practices for secondary insurance. We cover AthenaHealth-specific workflows and tools available. You will learn how to reduce denials. Revenue cycle management improves with proper processes. Follow these steps for better secondary claim success. Your practice will see faster payments and fewer. Implementation takes time, but the results are worth it.
Understanding Secondary Insurance in AthenaHealth
Secondary insurance pays after primary insurance pays claims. AthenaHealth helps manage this billing process. Understanding basics prevents billing errors.
What is Secondary Insurance
Secondary insurance covers remaining patient balances after primary. It pays copays and deductibles sometimes. Not all services are covered by secondary insurance. Coordination of benefits determines payment responsibility. AthenaHealth tracks both primary and secondary coverage. The system routes claims to the correct payer.
How AthenaHealth Handles Secondary Claims
AthenaHealth finds secondary insurance during registration. The system holds secondary claims until the primary pays. Electronic info from primary triggers secondary billing. Automated workflows reduce manual data entry errors. Claims route to secondary payer with primary payment. The system tracks claim status in real-time.
Common Secondary Insurance Scenarios
- Spouse coverage where both have employer insurance
- Medicare with Medigap or Medicare Advantage plans
- Workers comp with health insurance backup
Setting Up Secondary Insurance Correctly
Proper setup in AthenaHealth prevents most billing problems. Good data entry saves time during claims work. A good setup helps revenue cycle management.
Patient Registration Best Practices
Verify both primary and secondary insurance at check-in. Collect insurance cards and take clear photos. Enter policy numbers and group numbers correctly. Check subscriber info matches insurance cards. Update insurance info at every patient visit. Ask patients about recent insurance changes.
Insurance Verification Steps
Check primary insurance before the appointment. Verify secondary insurance coverage and benefits, too. Confirm coordination of benefits with both insurers. Document which insurance is primary in AthenaHealth. Check for any claim filing time limits. Verify patient responsibility amounts with both payers.
Coordination of Benefits Setup
| Insurance Type | Primary Payer | Secondary Payer | Filing Order |
| Spouse | Birthday rule | Older birthday | Primary first |
| Medicare + Private | Medicare primary | Private secondary | Medicare first |
| Auto Accident | Auto primary | Health secondary | Auto first |
Processing Secondary Claims Workflow
AthenaHealth streamlines secondary claims with automated workflows. Following proper steps ensures faster payment. Good workflow reduces claim denials.
Primary Claim Processing First
Submit primary claim through AthenaHealth. Wait for electronic info from primary payer. Review primary payment and adjustments. Check the primary paid right according to contract rates. Post primary payment to the patient account. Check for any primary claim denials.
Generating Secondary Claims
AthenaHealth makes secondary claims after primary pays. The system includes primary payment info on the secondary claim. Electronic claims go to the secondary payer. The claim includes an explanation of benefits from the primary payer. Patient responsibility is calculated based on both insurance payments.
Secondary Claim Follow-Up
Monitor secondary claims in the AthenaHealth dashboard. Follow up on pending secondary claims after 14 days. Check for secondary claim denials and rejections daily. Resolve denials quickly to prevent payment delays. Resubmit corrected claims through AthenaHealth right away. Document all follow-up activities in patient account notes.
Revenue Cycle Management with Secondary Payers
Good revenue cycle management needs attention to secondary. Secondary claims impact cash flow and accounts receivable.
Tracking Secondary Insurance Metrics
Monitor secondary claim denial rates monthly. Track average days to payment for secondary claims. Measure secondary collection rates compared to expected amounts. Calculate the percentage of revenue from secondary insurance payments. Identify common denial reasons from secondary payers.
Optimizing Secondary Collections
Set up automatic patient statements after secondary pays. Follow up on outstanding patient balances within 30 days. Offer payment plans for large patient amounts. Use the AthenaHealth patient portal for balance notifications. Send electronic statements to reduce mailing costs. Track patient payment trends and adjust collection strategies.
Improving Cash Flow
- Submit secondary claims within 24 hours of primary payment
- Follow up on aged secondary claims weekly
- Resolve denials within 48 hours
Common Secondary Insurance Claim Denials and Fixes
Understanding common denials helps prevent future problems. Quick fixes reduce lost revenue from denied claims. AthenaHealth tools help find and resolve denials.
Coordination of Benefits Denials
Primary insurance info is missing from the secondary claim. The wrong primary payer was listed on the secondary claim form. Primary payment amount not included on secondary claim. These denials need corrected claims with complete info. Resubmit with an explanation of benefits from the primary.
Timely Filing Denials
Secondary claims filed too late after the service date. Secondary filing deadline missed after primary payment. Each payer has different time limits for filing. AthenaHealth tracks filing deadlines to prevent late ones. Submit secondary claims right away after the primary pays. Monitor aged claims report weekly for deadlines.
Missing Information Denials
Claim lacks required primary insurance payment details. Explanation of benefits from the primary is not attached. Patient responsibility was not calculated correctly on the secondary claim. Resubmit the claim with all required info. Use AthenaHealth templates to ensure complete claim info. Create checklists for secondary claim submission.
AthenaHealth Tools for Secondary Insurance
AthenaHealth provides features for secondary insurance management. Using these tools improves efficiency and accuracy. Proper tool usage reduces manual work for staff.
Automated Secondary Claim Generation
The system makes secondary claims after primary payment posts. Claims include all required primary payment info. Electronic submission reduces claim processing time by 50 percent. Automatic claim generation reduces manual data entry errors. Staff review claims before submission. Bulk claim submission saves time.
Real-Time Claim Tracking
Dashboard shows the status of all secondary claims. Filter claims by payer, date, or claim status. Track claims from submission through payment. Set up alerts for denied or rejected claims. Monitor aging reports for secondary accounts. Drill down into individual claims for detailed info.
Reporting and Analytics
- Secondary claim denial rate reports show problem areas
- Collection rate reports track secondary insurance performance
- Days to payment reports identify slow-paying insurers
Conclusion
Handling secondary insurance in AthenaHealth needs proper setup and workflows. Good patient registration and insurance verification prevent most errors. Automated claim generation and tracking improve efficiency and revenue. Understanding common denials helps resolve issues quickly. Revenue cycle management improves with proper secondary insurance processes. Following these best practices increases revenue and reduces denials.
FAQs
Q1: How long should I wait before submitting secondary claims?
Submit right away after the primary payment posts. Do not wait more than 24 hours. Quick submission prevents timely filing denials. AthenaHealth can automate this process for you.
Q2: What info does the secondary claim need from the primary?
You need the primary payment amount on the claim. Include all adjustments from the primary payer. Attach the explanation of benefits from primary insurance. Patient responsibility must be calculated correctly, too.
Q3: Can AthenaHealth automatically submit secondary claims?
Yes, the system can make and submit secondary claims. It does this after the primary payment posts automatically. Staff should review claims before they go out. Automation saves time and reduces manual errors.
Q4: How do I fix the coordination of benefits denials?
Resubmit with correct primary insurance info and EOB. Check which insurance should be primary first. Update the coordination of benefits in the AthenaHealth system. Most of these denials resolve quickly with the right info.
Q5: What is the average payment time for secondary?
Most secondary payers process claims within 30 days. Some payers are faster than others, though. Follow up after 14 days if no payment. Track payment times to identify slow payers.
