Question

When a patient is covered by the same primary and secondary commercial health insurance plan, what should be done?

1) Submit just one CMS-1500 to the payer.
2) Mail the remittance advice to the payer.
3) Send the secondary CMS-1500, but not the primary claim.
4) Complete and submit two CMS-1500 claims.

Answer 1

Submit a CMS-1500 claim to the primary insurer first, then submit the secondary claim with the primary insurer's remittance advice.

Step-by-step explanation:

When a patient has dual coverage with both a primary and secondary commercial health insurance plan, it is important to handle billing procedures correctly. The typical process involves first submitting a CMS-1500 claim form to the primary insurer. After processing by the primary insurer, the secondary claim can then be submitted, usually along with the remittance advice from the primary insurer showing what was covered and the amount of patient responsibility. It is not sufficient to submit just one CMS-1500 claim or to send only the secondary claim without processing by the primary insurer.

Therefore, one must complete and submit two CMS-1500 claims, making certain that the secondary insurer receives all necessary information from the primary claim to process the secondary coverage. This claim form should include all the necessary information for both the primary and secondary insurance plans. Submitting just one claim form ensures that the payer has all the information they need to process the claim correctly.