Secondary Claims for Therapists: What Happens Next
Secondary claims for therapists are the claims you send to a second insurer after the first one pays. Many clients have two plans. If no one bills the second plan, money stays unpaid. This guide explains how secondary billing works and how to keep it from slipping.
What are secondary claims for therapists?
When a client has two plans, the primary plan pays first. The secondary plan may pay part of what is left. Our secondary claims guide gives the basics. The process depends on claim adjudication by the first payer.
How secondary billing works
- Confirm both plans. Check which is primary during eligibility verification.
- Bill the primary. Wait for the payment and remittance advice.
- Send the secondary claim. Many payers need the primary’s payment details attached. Claims often travel through a clearinghouse. See electronic claims for therapists.
- Post both payments. Write off only what the contracts allow.
- Bill the client last. Only for the amount the plans say the client owes.
Where secondary claims go wrong
- Primary and secondary are reversed.
- The secondary claim is never sent.
- Missing primary payment data.
- Late submission. See timely filing.
Rules for who is primary come from the plans and, for some cases, from the CMS coordination of benefits information.
Private payers vs Medicare vs Medicaid
Private payers follow their own coordination rules. Medicare can be primary or secondary, depending on the situation. Medicaid is generally the payer of last resort, so other coverage is billed first, and state rules vary. See Medicaid managed care and Medicare behavioral health billing.
How MCM South handles secondary claims for therapists
MCM South Medical Billing Service, LLC bills secondary claims for psychotherapists and psychiatrists. See secondary claims billing. Related reading: what a billing service includes and denied claim follow-up. View our services.
Why secondary claims for therapists get missed
Practices focus on the first payment. Once the primary pays, the claim looks closed. A secondary balance may sit unbilled because nothing in the workflow prompts anyone to send it. The fix is a flag on every client with two plans, and a step in your process that says: after the primary pays, check for a secondary.
What to tell clients about two plans
Ask clients to tell you when their coverage changes. Ask for both cards at intake and each year. Explain that you will bill the second plan when it applies. When clients understand the process, they are more likely to give you updates, and your claims go to the right payer the first time.
Key takeaways
Secondary claims for therapists are easy to forget and easy to fix. Record both plans at intake, flag the client, wait for the primary payment and then send the second claim with the details the payer needs. Review open balances each month. If you do these four things, you capture payments that many practices leave behind.
A simple secondary-claim checklist
- Record both plans at intake.
- Update insurance each year.
- Flag every claim with a second plan.
- Review unpaid balances monthly.
For more habits that protect payment, read billing mistakes therapists make.
Frequently asked questions
Who pays first when a client has two plans?
The plans decide using coordination of benefits rules. Check with each payer.
Do I need to send paper claims for secondary billing?
Often no. Many payers accept electronic secondary claims.
Can I bill the client the balance?
Only after both plans have processed the claim and your contracts allow it.
What if the client’s plans changed?
Update the record and rebill if needed. Check filing deadlines.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.
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