When a client has more than one insurance plan, a secondary claim lets you bill the next payer for any balance left after the primary payer has responded. Carepatron carries forward the primary payer's payment and adjustment details automatically, so the secondary payer has everything they need to determine what they owe.
Each secondary claim has its own lifecycle in Carepatron, which means you can manage different service codes or modifier requirements between payers without any conflict.
When would you use this?
Commercial plan + Medicaid. Your client has a commercial primary plan and Medicaid as secondary. Once the commercial payer pays or denies the claim, you bill the remaining balance to Medicaid.
Medicare is secondary. Your client's employer group health plan is primary. You'll need to submit to the primary payer first, even if you expect a denial, before Medicare will accept your secondary claim.
Medicare Secondary Payer (MSP). You need the primary payer to know that Medicare is secondary before they process the claim, so they return the correct remittance information.
Key concepts
Payer sequence: The order in which payers are billed: Primary → Secondary → Tertiary. Set a policy and reflect on each claim.
Claim remittance (EOB): The payment and adjustment record returned by a payer after processing a claim. Also called an Explanation of Benefits. Electronic remittances arrive as ERAs and are posted automatically; paper or other responses can be entered manually.
Prior payments & adjustments: The payment amount and adjustment reason codes from the primary remittance are carried across to the secondary claim. These tell the secondary payer what was already paid and why any amounts were adjusted.
Before you start
Make sure the following are in place:
Your primary claim has a status of Paid or Processed.
Your client has a secondary insurance policy on file.
The primary claim has at least one claim remittance — either received electronically as an ERA or entered by you manually.
Creating a secondary claim
Secondary claims are created directly from the processed primary claim.
Here's how to do it:
Open the primary claim from the client's billing page.
Click Create secondary claim in the claim header.
In the Secondary claim panel, confirm or adjust three fields:
Claim remittance — the remittance record from the primary claim that contains the payment and adjustment data. The most recent remittance is selected automatically. You can select a different one, or click Add new claim remittance to enter one manually.
Secondary insurance — the client's secondary insurance policy to bill.
Billable items — the services to include. All eligible items from the primary claim are selected by default.
Click Create. The secondary claim is generated and opened automatically.
Note: The secondary claim is pre-populated with all client details, rendering providers, and service lines from the primary claim.
The primary payer's details — payer name, payer ID, policy holder, member ID, group number, payment date, amount paid, and per-service adjustment codes — are captured in the Insurance information section.
Keeping track of linked claims through claim history
Once your secondary claim is created, both claims are linked to each other:
The primary claim's Activity log shows a link to the secondary claim.
The secondary claim's Activity log links back to the primary.
You'll also see both claims listed separately in your billing list, each labelled with their payer sequence (Primary / Secondary / Tertiary), so nothing gets mixed up.
What's in the secondary claim form
You will find the following on the secondary claim form:
1. Insurance information
The Insurance information section of a secondary claim contains a card for the primary insurance.
Expand it to see:
Prior claim details — the linked primary claim and the claim remittance used to populate the adjustment data. Use the Choose claim and Choose claim remittance dropdowns to select a different prior claim or remittance if needed.
Payer details — the primary payer's ID, name, insurance type, coverage type, and address, as captured at the time the secondary claim was created.
Policy details — the policy holder's name, date of birth, address, member ID, and group number.
2. Claim remittance details
Click the remittance card to open the claim remittance advice panel:
Date received, payer name, clearing house reference
Total billed, total adjustments, client responsibility, and payment amount
An itemised table of services with fees, adjustment codes, and amounts paid
A glossary explaining each adjustment code shown
This information is also available in the primary claim's activity history.
3. Billing items & adjustments
The billing items & adjustments section shows all service lines on the secondary claim. Each service line includes an items and adjustments subsection that displays the payment recorded on the linked remittance:
The payer name, payment date, and total amount paid for that service line.
A breakdown of adjustments — each showing the adjustment group, code, reason description, and adjustment amount.
This data is what the secondary payer uses to determine their own liability.
Creating a remittance manually
If you didn't receive an ERA for the primary claim — for example, the payer responded by phone, fax, or paper EOB — you can enter the remittance yourself.
Click Add new claim remittance in the secondary claim creation panel, or use the Choose claim remittance dropdown on the claim form.
You'll be asked to fill in:
Payer — name and payer ID
Payment date and payment method
Reference numbers — remittance and payment references
Service lines — one row per billed service, with fields for amount billed, amount allowed, amount paid, and adjustment codes/amounts with reasons
Remittance document — optionally upload a paper EOB or any payer correspondence to keep on file
Once saved, the remittance will be available to select when creating a secondary claim from that same primary claim.
Adding a secondary payer to a primary claim
If Medicare is your client's secondary payer, you'll need to let the primary payer know before you submit, so they return the right remittance information. Set this up on the primary claim before sending it out.
Open your primary claim in Draft or Validated status.
In the Insurance information section, click Add additional payer.
Select your client's secondary Medicare policy.
Set the Medicare type code to the applicable reason.
Save and submit the primary claim as you normally would.
Our team will be able to answer any other questions you may have. Just reply via messenger through the Help channel in your workspace.