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Filing Secondary and Tertiary Insurance Claims

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When we first started our medical billing business in 1994 I had no previous experience at billing any medical claims, let alone secondary and tertiary. (You mean some people have 3 insurances?) I knew nothing. In fourteen years of billing I've learned quite a bit and I see from questions in our forum that many beginners do not understand secondary and tertiary claims billing at all.


When we first started our medical billing business in 1994 I had no previous experience at billing any medical claims, let alone secondary and tertiary. (You mean some people have 3 insurances?) I knew nothing. In fourteen years of billing I've learned quite a bit and I see from questions in our forum that many beginners do not understand secondary and tertiary claims billing at all.

First of all, how does anyone get two or three policies and which is determined primary? If a husband and a wife both work (who doesn't?) and they are both covered by health insurance by their employers, they may both have family policies so they are both covered under each others plan. One would be primary and the other secondary. Now if one of this couple (a few years ago we would have assumed that it would only be the husband) had previous military experience and carried over their Tricare military insurance, that would be the third payor (if there was a balance left).

Which company is primary and which one is secondary is determined by one of a couple different methods. First of all, if a person is working and they carry insurance, that insurance is primary (unless they have Medicare and their employer has less than 100 employees). If a person is retired and has Medicare but the spouse works and carries a family policy, then the spouse's plan would be primary and the Medicare would be secondary.

There is no way to cover every scenario but basically whether or not the person or the spouse is working can determine the order. For dependents (usually children) some go by the "birthday rule" meaning that whichever parents birthday falls first in the year is primary. Of course with all of the divorce out there sometimes the order of insurance is determined by a court order.
When a patient is seen by a provider the claim is sent on a CMS 1500 form to the primary insurance carrier either electronically or on paper. Electronically it can be sent either directly to the insurance carrier by special software or through a service or through a clearing house. When sent on paper it simple means the claim is printed to a paper CMS 1500 form and sent through the mail. Whatever the case is, it is important that you know the order of the policies.

Once the primary insurance carrier pays their share of the claim it is then submitted to the secondary insurance company if the patient has one. Secondary claims can also be sent electronically and on paper. Medicare is mandating electronic submissions even on secondary claims. When submitted electronically all the information from the eob (explanation of benefits) is entered into the claim information and submitted to the secondary insurance carrier.

When the secondary is submitted on paper, the claim is printed out again on a cms form and a photocopy of the eob is attached. If other patients are listed on the eob, their personal information should be hidden. Many offices use black markers (we call them smelly pens) to draw through the unwanted information. I've set up a bunch of various width strips of white cardboard that we slide into clear report covers to cover the unwanted information before we photocopy. We only do this with companies that are not yet accepting electronic submissions.

If there is still a balance after the secondary insurance carrier pays their share, the claim is sent on to the third carrier. It is printed out again on a cms form and copies of the eobs of both the primary and the secondary insurance carriers are attached.

Whenever you send secondary and tertiary claims on paper, make sure the photocopies you attach are clear, easy to read, and for the correct date of service. Many insurance carriers scan the eobs which lightens them a little. If the copy you submitted was already light, by the time the claim is processed it may be sent back to you as unreadable. It takes a lot more time to find the original eob and resubmit a claim than it does to get it right the first time.

Secondary and tertiary claims can sometimes seem like a pain to get paid - especially because they can be for a very small amount of money. It is still important to file and track these claims to keep your receivables under control. It may not seem like a lot of money but it adds up. If you have a system for submitting them it really isn't that bad.

Alice Scott and her daughter / partner Michele Redmond are co-owners of a medical billing service. They offer an informational website for anyone looking for information or help with their problems with medical insurance billing. Here are more articles on submitting insurance claims. You can also sign up for their free monthly newsletter or join their free medical billing forum to get answers to your billing questions.
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Long-Term Care Insurance Industry - 2009 Forecast and Trends

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As we enter 2009, some significant trends are impacting the long-term care insurance industry.Heightened consumer awareness, younger buyers, reformulated products and the intensification of multi-life sales -- have led to a steady growth of long-term care insurance policies. Despite some adverse factors -- in particular, the weakened economy -- we anticipate that sales for the just-ended year will be in the 385,000 policy (and group certificate) range, with premiums up several percent over the prior year. For 2009, our predictions all point to continued growth in the number of Americans who are purchasing this form of protection.

As we enter 2009, some significant trends are impacting the long-term care insurance industry.
Heightened consumer awareness, younger buyers, reformulated products and the intensification of multi-life sales -- have led to a steady growth of long-term care insurance policies. Despite some adverse factors -- in particular, the weakened economy -- we anticipate that sales for the just-ended year will be in the 385,000 policy (and group certificate) range, with premiums up several percent over the prior year. For 2009, our predictions all point to continued growth in the number of Americans who are purchasing this form of protection.

What's driving the continued growth of new policy sales, and how can insurance professionals capitalize in the year to come? The industry is benefiting from heightened positive coverage within consumer print and broadcast media about the importance of long term care planning. More importantly, many of the reports convey important information about the best ages to start planning (with a slant toward pre-retirement) and what constitutes appropriate and affordable coverage. News stories are actually telling consumers when and how to procure insurance protection.

Once primarily a senior product, buyers of long term care insurance continue to get younger. As recently as 2000, the average policy was written on a 67-year-old. Last year, according to Association studies, some 83 percent of all new individual applicants were under the age of 65, while the average age was 58. As a result of the significant demographic shift, leading insurers have retooled their product offerings to address the two primary concerns of younger buyers: affordability and the concern about paying many years for something that might not be needed.
The result has been the introduction of a variety of "life stage" long term care insurance policies that enable policyholders to lock-in their health insurability and purchase a more limited level of protection with the future ability to purchase additional coverage periodically in the future. Provisions for these policies vary, and it's fair to recognize that the added coverage is purchased at attained-age rates. That said, the ability of agents to now allow pre-retirement-age buyers to "kick the tires" by owning some long-term care insurance offers one of the greatest opportunities to expand and grow market penetration into the future.

Looking ahead, three significant marketing opportunities will likely yield the greatest results for producers seeking to identify new prospects or convert their existing clientele into long-term care insurance prospects.

The first is recognition of maturing awareness among consumers. The industry has entered a new phase of awareness; one that requires focus on new messaging pertaining to health insurability, affordability and the ability to receive care in one's own home.

For those targeting seniors, the increasing number of states rolling out LTC Partnership policies has generated a good deal of excitement among insurance agents who must now complete additional continuing education training. The opportunity to build sales -- especially among middle-income consumers -- will be predicated on the willingness and ability of states, insurers and agents to promote the importance of LTC planning, coupled with the key benefits provided by Partnership provisions. It's still very early in that process.

Watch for the announcement regarding the Federal government's long-term care insurance offering; currently the nation's largest long-term care insurance group plan. The first Federal open enrollment resulted in some 270,000 individuals purchasing coverage. When the federal plan opens enrollment again (expected later in 2009), there will again be a most positive spillover effect that will boost sales across the country.

Finally, the message of affordability continues to provide the greatest opportunity to overcome existing mis-perceptions. Studies repeatedly validate what's been known for well over a decade; that consumers perceive the cost of LTC insurance to be higher than it really is. A message of affordability always plays well. It's one that, to date, has not been widely used; but expect that to change as more aggressive marketing techniques heat up.

For free audios on selling long-term care insurance visit the Producer's Resource Center of the American Association for Long-Term Care Insurance.

Jesse Slome is Executive Director of the American Association for Long-Term Care Insurance. The industry trade organization does not sell insurance products but maintains an excellent website for consumers seeking additional information on the subject. If you would like to receive a no-obligation free quote from a member of the Association, visit our Consumer Information Center.
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Personal Property Insurance Basics and Tips

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Imagine that a huge tropical storm struck your area. Your home and your car were insured, so they can be replaced. But did you have personal property insurance for your other important items?

This type of coverage is actually offered within your renters or homeowners insurance policy. What this does is cover all of the goods in your home that are not attached to it permanently. This would include objects like furniture, books, computers, clothing, and other appliances. For most carriers, you will be covered for up to forty percent of the value of your residence policy.
Imagine that a huge tropical storm struck your area. Your home and your car were insured, so they can be replaced. But did you have personal property insurance for your other important items?

This type of coverage is actually offered within your renters or homeowners insurance policy. What this does is cover all of the goods in your home that are not attached to it permanently. This would include objects like furniture, books, computers, clothing, and other appliances. For most carriers, you will be covered for up to forty percent of the value of your residence policy.

There is somewhat of a hitch to the forty percent in a standard homeowners insurance policy, however. Fine and hard to replace possessions as a whole are only protected for up to one thousand dollars. This means any group of items that include firearms, silverware, jewelry, furs, watches, and documents. Agencies do this in hopes of encouraging folks to purchase extra personal property insurance. It is recommended to do this if you own many of these types of valuables.

Something you will want to do at some point is to make a list of your belongings. This is so you are prepared in the event of fire, flood, or theft. Things will go much more smoothly in general dealing with the agent and paperwork. Make an inventory list in categories to make it easier, being sure you do not miss much.

After your inventory is complete, you need to sit down and make an estimate of the cost of replacement for it all. Take into account that clothing and everyday items like that lose their value over time. On the other hand, some electronics and memorabilia appreciate in amount. Once you have the estimate, put this away in a file in a safe deposit box. Eventually add to it any sales receipts, serial numbers, or video or picture evidence. Keep it updated!

A natural disaster or theft can occur to anyone at anytime. You don't want to lose everything you have and not be able to replace any of it. Make sure you have personal property insurance with your other policies!

Make sure that your homeowners insurance policy covers all your personal belongings. Having adequate personal property insurance will insure that all your belongings are sufficiently covered.

Article Source: http://EzineArticles.com/?expert=Frank_Rodriguez
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Personal Property Insurance - What You Need to Know

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You probably own things like home, health, life, and car insurance policies. But do you have personal property insurance for the items in your home? Here is some information on how it works.This particular type of coverage is actually part of your home or renters insurance policy.
That is, if you opted for it when you were signing up. It can offer you protection on any items in the home that are not permanently fixed to the establishment. This would mean things such as electronics, books, clothing, and appliances. The majority of carriers cover up to forty percent of the amount that you have on the actual residence itself.
You probably own things like home, health, life, and car insurance policies. But do you have personal property insurance for the items in your home? Here is some information on how it works.

This particular type of coverage is actually part of your home or renters insurance policy. That is, if you opted for it when you were signing up. It can offer you protection on any items in the home that are not permanently fixed to the establishment. This would mean things such as electronics, books, clothing, and appliances. The majority of carriers cover up to forty percent of the amount that you have on the actual residence itself.

However, there is something you should be aware of. Coverage is still limited further on certain types of valuables. Anything like expensive jewelry, watches, furs, firearms, and other hard to replace objects have limits. Everything like that combined is only covered up to one thousand dollars in a standard contract. This is mainly to encourage people to buy extra coverage, which you would obviously want to do if you bought more fine items.

You'll want to go ahead at some point and make a complete inventory list of things in your home. This is to help you keep track. Also, in the event of something like theft, flood, or fire, you are better prepared. There will not be as much guesswork when you are filing your claim. Just walk around your place, listing everything as you go. It may help to categorize so you don't miss things.

Your next step is to work out an estimate of what everything is worth. This is in terms of replacement costs. Some items lose their value over time, and some actually gain more. Anything that could be collectible would appreciate, while items like clothing would depreciate. Make yourself a file for this list, and then make additions such as sales receipts, pictures or video, and serial numbers.

Personal property insurance actually sounds pretty important, doesn't it? Well, you're right, it definitely is. Check with your home or renters insurance policy to make sure you have adequate property insurance coverage!

It's important that your home or renters insurance :
http://www.themoneyalert.com/rentersinsurance.html, coverage offers comprehensive property protection. Take a look at your policy to make sure you have enough personal property insurance : http://www.themoneyalert.com/personalpropertyinsurance.html to meet your families needs.

Article Source: http://EzineArticles.com/?expert=Frank_Rodriguez
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Using a Homeowners Insurance Calculator

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You want to get your home insured for a homeowners insurance. What would you do? The first option that would come to your mind would be to contact an insurance agent and get the policy form him with out knowing anything else about it. You have the policy and the agent is happy with his commissions. Well you need to know more about your homeowners insurance than that to avoid any kind of problems when it comes to making actual claims.
The best way to go about it is to do some research yourself. When you do this research you can consult the rating agencies of your state or even the internet can be a very good source of information. Find out what companies give the best deals out there and what kind of coverage they are giving, then the most important factor is to know about the service of the insurance company.
You want to get your home insured for a homeowners insurance. What would you do? The first option that would come to your mind would be to contact an insurance agent and get the policy form him with out knowing anything else about it. You have the policy and the agent is happy with his commissions. Well you need to know more about your homeowners insurance than that to avoid any kind of problems when it comes to making actual claims.

The best way to go about it is to do some research yourself. When you do this research you can consult the rating agencies of your state or even the internet can be a very good source of information. Find out what companies give the best deals out there and what kind of coverage they are giving, then the most important factor is to know about the service of the insurance company.

Homeowners insurance calculator help you in getting instant quotes for your policy. This is particularly useful tool if you have to compare what is available with different companies and how can you get the best rates for the kind of coverage you want. A lot of times the cheapest deal is not the best deal when it comes to coverage.

Even while using the homeowners insurance calculator you don't get the accurate results because there are some factors which can not be taken into consideration by the calculator but they affect your costs to a great extent. Some of these factors can be the location of your home or the construction of your home. Final and accurate figures can be found out only by an inspection or a visit by an official. A calculator however can give you estimates which you can compare to choose a policy for yourself. So it is always better to do a little bit of research before going for any kind of insurance.

For more information on a homeowners insurance calculator you can visit Texas homeowners insurance.
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How Much Do You Know About Auto Repair Insurance?

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We all know what Auto Insurance is, but what is auto repair insurance?A lot of people insure their car(s), but don't insure the repairs that their car(s) will invariably need. You're probably wondering why people miss this vital step. The answer is because the average American hasn't had enough exposure to this kind of insurance, and isn't well-versed on the advantages of owning auto repair insurance. You see, after the warranty on your car has expired, this policy will keep you from high repair bills.How Auto Repair Insurance Works?

We all know what Auto Insurance is, but what is auto repair insurance?

A lot of people insure their car(s), but don't insure the repairs that their car(s) will invariably need. You're probably wondering why people miss this vital step. The answer is because the average American hasn't had enough exposure to this kind of insurance, and isn't well-versed on the advantages of owning auto repair insurance. You see, after the warranty on your car has expired, this policy will keep you from high repair bills.

How Auto Repair Insurance Works

Similar to other types of insurance, an auto repair insurance policy is a contract between a vehicle owner and the car insurance company which puts the responsibility of repair bill payment on the shoulders of the insurance company - not the car owner - during the insured time period.

Every state and every company has its own particular details of coverage and exclusions, and this kind of insurance isn't regulated nationally - so there is a lot of variation across state lines. This is precisely why it is so crucial to become familiar with all the relevant terms and conditions of.

What It Covers

A standard auto repair insurance policy covers the breakdown of your car Here is where we start seeing variation in coverage, for example, a portion of the policies are written such that they only covered expenses are parts that break-down, meaning they are only liable for expenses due to parts that broke. Should you also want a policy that will cover the slow breakdown of parts, you need to read the policy details carefully to make sure it covers parts that wear out over time. A lot of companies do not offer both coverages.

While there are also auto repair insurance policies that cover the engine, transmission, and other parts of a vehicle through which oil flows. However, this would be least preferable in terms of coverage, because most of the car's components aren't covered in this policy.

Bumper-to-bumper policies are also available from some car insurance companies, which cover nearly all the mechanical systems of a vehicle. An non-covered items would be specified. For instance, an auto repair insurance policy might not cover .

Another important consideration before purchasing - besides all the above-mentioned points about making sure you know all your auto repair insurance policy details - is to know how much you will be paying by way of deductibles.

Even if the manufacturer's warranty has lapsed, your car can be covered until it reaches the 100,000 mile mark. But keep in mind that as your vehicle clocks up the miles, your policy will also ratchet up in price

Something interesting to bear in mind: if you buy a transferable auto repair insurance policy, the policy can transfer to the next owner - so you can sell your car for a lot more money!

The majority of people understand the benefit of a well-rounded auto insurance policy, few truly understand how auto repair insurance {protects you from costly and sometimes untimely repair bills. Now you have a better understanding of how it works, you'll know if this is something you want to look into further.

Thanks for reading my article. I go to
http://www.insurancequoteslady.com/auto/AutoRepairInsurance.html whenever I am researching different insurance-related topics.
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Homeowners Insurance Company Ratings - An Important Factor When Shopping For Coverage

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If you're entering the real estate market and looking to buy a home you are also going to have to look into buying homeowners insurance. If you're borrowing money to pay for a new home there is a very strong chance that your lender requires that you insure your home or they will not lend you the money. Whether you are a new home buyer looking to obtain coverage for the first time or you are a longtime homeowner looking to get a better deal on your coverage you may want to look into some homeowners insurance company ratings to help you make your decision.
If you're entering the real estate market and looking to buy a home you are also going to have to look into buying homeowners insurance. If you're borrowing money to pay for a new home there is a very strong chance that your lender requires that you insure your home or they will not lend you the money. Whether you are a new home buyer looking to obtain coverage for the first time or you are a longtime homeowner looking to get a better deal on your coverage you may want to look into some homeowners insurance company ratings to help you make your decision.

Whenever you do any comparison shopping price is obviously a factor. Everyone wants to get the most value for the money they spend but in addition to price there are some other factors to keep in mind. It's a good idea to go with a company that is financially strong. If your insurance company doesn't have enough money to cover your claims this could lead to some serious headaches at some point in the future.

In addition to the financial stability of the company you choose to go with you may want to look into some other things such as consumer reviews and the company's customer service record. There are a number of places that you can go to find homeowners insurance company ratings so that you can make an informed decision.

Some of these places include:

The National Association of Insurance Commissioners - The NAIC has a website at - naic.org where you can select your state and be redirected to your state's Department of Insurance website. Your state's website will have a lot of information about any insurance providers operating in your state. The information will include things like a list of licensed agents and any complaints that may have been filed against the company.

A. M. Best Company - This company reviews many insurance providers and evaluates them on a number of different factors including the strength of the company and whether it's under regulatory supervision.

J. D. Power company - J. D. Power conducts consumer surveys and rates companies based on prices, policy options, the way they handle claims, and customer service.

There's a lot to think about when you're shopping for homeowners insurance. After you've determined the type of coverage and the amount of coverage that you need its a good idea to evaluate any companies you might consider going with by finding homeowners insurance company ratings to help you make the most informed decision possible. And of course when shopping for anything price is always a factor. The good news is that you can get multiple online insurance quotes in just a matter of minutes and this makes finding the best price one of the easiest parts of the entire process.

To get free homeowners insurance quotes from highly rated companies or to get a list of top insurance providers in your area visit http://get-homeowners-insurance-quotes.com/
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