Efficiently tracking primary and secondary payments in your billing system is essential for accurate revenue management, reducing claim errors, and ensuring proper patient billing. Without clear tracking, you risk lost payments, duplicate billing, or delayed collections.
In dual insurance scenarios, payments follow this sequence:
Submit the claim to the primary insurance
Post the primary payer’s payment and adjustments
Submit the remaining balance to the secondary payer, along with the primary Explanation of Benefits (EOB)
Post the secondary payment and final adjustments
Bill the patient for any remaining responsibility only after both payers have processed the claim
Your billing system should reflect each of these stages clearly.
Ensure your billing software includes separate fields for:
Primary claim status (e.g., submitted, paid, denied)
Secondary claim status (e.g., pending, sent, paid, denied)
Payment dates and amounts for each payer
Adjustment reasons and codes (e.g., CO-45 for contractual write-offs)
This allows your billing team to quickly assess which claims are complete and which need attention.
When posting payments:
Enter primary payments and adjustments first, directly from the primary EOB
After the secondary payer processes the claim, post their payment as a separate transaction
Include denial codes, zero-pays, and write-offs as needed for full transparency
Avoid combining both payments into a single entry—this can lead to reporting inaccuracies and audit issues.
Apply appropriate adjustment codes for:
Contractual write-offs
Patient responsibility (copay, coinsurance, deductible)
Payer denials
Coordination of Benefits discrepancies
These codes provide a clear record of why certain amounts were not paid and help in follow-up or appeal efforts.
Use your billing system to flag claims that:
Are awaiting a primary EOB before secondary submission
Have been submitted to secondary but not yet paid
Have timely filing deadlines approaching
Automation helps ensure no claim slips through the cracks.
Run monthly or weekly reports that include:
Claims with only primary payments posted
Claims with both primary and secondary payments
Pending secondary submissions
Outstanding patient balances after secondary processing
These reports help track reimbursement status and ensure all accounts are closed out properly.
Include internal notes for every major action, such as:
"Primary paid on [date], awaiting secondary EOB"
"Secondary denied due to missing COB, resubmitted [date]"
"Patient billed after secondary processing complete"
Well-documented notes improve team communication and support audit readiness.
Tracking primary and secondary payments in your billing system requires attention to detail, accurate data entry, and consistent workflows. By using claim status fields, proper codes, and timely follow-up, your team can ensure complete, compliant, and profitable claim processing.