Secondary Claims for Mental Health: 5 Easy Steps to Follow

Secondary claims for mental health practices start with one question: which plan pays first? Coordination of benefits (COB) answers it. When a patient has two plans, the primary plan pays first and the secondary plan may pay part of what is left. This guide is written for psychotherapists and psychiatrists.

Coordination of benefits: who pays first?

CMS describes COB as the process that decides which plan has primary payment responsibility when a person has more than one plan. CMS also says COB makes sure combined payments do not exceed 100% of the claim. If CMS systems show another insurer is primary, Medicare denies the claim and tells the provider to bill the correct party. See the CMS coordination of benefits page for details. The glossary entry for Medicare Secondary Payer explains the Medicare side.

Secondary claims for mental health: 5 steps to bill

• Confirm both plans before the visit. Our insurance verification service identifies the primary insurance and the secondary insurance up front.
• Bill the primary plan first. A secondary claim sent before the primary pays is usually denied.
• Read the primary payer’s response. The remittance advice or explanation of benefits shows what was paid, adjusted and left for the patient. Our guide to reading CARC and RARC codes helps with the codes.
• Send the secondary claim with the primary’s payment details. Most secondary payers need them. Each payer sets its own rules, so confirm them.
• Post and follow up. Track the secondary until it pays or is denied, and watch the filing limit for each plan.

Crossover claims

A crossover claim is a Medicare-paid claim passed to another insurer for the secondary payment. CMS says the COB Agreement (COBA) program sets a national contract for sharing eligibility data and Medicare-paid claims. CMS also says automatic crossover needs an agreement in place between its Benefits Coordination and Recovery Center and the insurer. Without one, the person with Medicare must coordinate the secondary payment directly with the other insurer. So when a secondary does not arrive, check whether crossover applies before you rebill.

Children with two plans

When parents each have coverage for a child, many plans use the birthday rule to decide which plan is primary. Secondary claims for mental health on a child’s chart often turn on the birthday rule. Our post on the birthday rule and coordination of benefits walks through it, including state differences.

Private payers, Medicare and Medicaid, and state rules

• Private payers: each plan sets its own secondary rules and filing limits. Our insurance contact guides by state point to each insurer’s provider page.
• Medicare and Medicaid: federal and state programs have their own COB rules. CMS describes the Medicare side. Check your state Medicaid agency for Medicaid.
• State law: COB rules can differ by state. Confirm with your state insurance department. This is operational guidance, not legal advice.

How MCM South handles secondary claims for mental health practices

MCM South serves psychotherapists and psychiatrists. Our secondary claims billing service sends the second claim after the first pays and follows it to payment. Psychiatric prescribers often bill more than one line per visit, so the primary payer’s response for each line matters. Denials on either claim go through our denied claims follow-up and appeals work.

Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We bill for solo and medium-size mental and behavioral health practices only.

The short version

• Secondary claims for mental health start with finding out who pays first, before the visit.
• Bill the primary first, then send the secondary with the primary’s payment details.
• Medicare crossover depends on an agreement between CMS and the insurer.
• Keep private, Medicare, Medicaid and state rules separate.
• MCM South can bill the secondary for you. See our billing services.

Sources checked (10/26/26)

• CMS, Coordination of Benefits

Frequently asked questions

Frequently asked questions