Bill to a Primary Payer or a Prior Payer

A primary claim can be submitted to wrap payers to fulfill the payer’s requirement of submission as a primary claim even though they are actually secondary to an HMO or PPO. You can also bill these wrap claims simultaneously with the prior claim, which reduces the work required to manually flag charges for every encounter to bill both payers. For example, a secondary claim will bill with the primary and a tertiary claim will bill with the secondary one.

When you set wrap payer claims to always bill as primary, data from other payers that might have been attached is omitted regardless of the encounter COB order. The wrap payers are typically Medicare and Medicaid wrap payers that remit a flat rate that is secondary to a primary HMO- or PPO-contracted primary payer. The payers can also be tertiary.