Does the Primary Payer Forward EDI 837P Claims to the Secondary Payer?


Does the Primary Payer Forward EDI 837P
Claims to the Secondary Payer?


When you include secondary payer information in the EDI 837P claim sent to the primary payer, the primary payer will not automatically forward the claim to the secondary payer.

Claim Processing Steps:

  1. The primary payer processes the claim and determines the amount covered.
  2. An 835 Electronic Remittance Advice (ERA) or an Explanation of Benefits (EOB) is issued.
  3. If there is a remaining balance, the provider must manually submit the claim to the secondary payer.

Exceptions:

  • Medicare Crossover Claims: If Medicare is the primary payer and the patient has a secondary payer on file, Medicare automatically forwards the claim. Learn more.
  • Some Commercial Payers: A few private insurers may have agreements to auto-forward claims, but this is uncommon. Read about COB.

Best Practices:

  • Verify if the primary payer has an auto-forwarding agreement with the secondary payer.
  • Manually submit the secondary claim using an EDI 837P with COB (Coordination of Benefits) data. EDI 837 Guide.
  • Ensure proper secondary payer details are captured to avoid claim rejections. Understanding Claims Processing.