This page describes how to create a tertiary claim. The following conditions must be met before creating a tertiary claim.
- The primary claim has been created and the primary payment has been posted.
- The secondary claim has been created and the COB payment has been posted.
- The tertiary payer has been added to the patient’s chart as a paper payer or electronic payer with a paper mailing address. Tertiary claims cannot be submitted electronically.
- Navigate to the patient’s chart. For a list of recent patients, hover over Patients and select Recent Patients. The list displays on the right.
- To find a patient, enter their name in the search box.
- Click Ledger.
- Write-off the patient responsibility. Click the patient balance dollar amount (blue hyperlink). For instructions, go to How to Write Off a Patient Balance.
- Search for the primary claim. Click Advanced (next to the search box).
- Click Payment Detail.
- To create a claim, click Copy.
- Under Bill To, change payer to the tertiary payer.
- Under Claim Transmission, select Print Locally on CMS-1500.
- Click Create Claim.
- Print the claim on a CMS-1500 form, attach the primary and secondary EOBs, and mail to the payer.
- When payment is received, post the payment as normal.