When to bill secondary insurance for ABA services?

[yanyos]

Hello,

Can someone give me a few billing examples for ABA services?

What would be a typical process or steps to take to decide when to bill the secondary insurances ( commercial, medical, medicare, IEHP) ?

Thank you

 

[DS4]

I'm relative new to selling senior products. What are ABA services?

 

[yanyos]

Applied Behavior Analysis

Is there any general rule for secondary additional to :

If secondary paid less than primary for same service you don't need to bill secondary.

 

[DS4]

Generally, Medicare is secondary(paying nothing). Unless employer is less than 20 employees. Then, Medicare is primary.

 

[yanyos]

If the secondary is a commercial as well? is always the same formula? identify how much they would pay if they were primary ins, so if they will pay less no need of bill secondary?

 

[somarco]

If the secondary is a commercial as well? is always the same formula? identify how much they would pay if they were primary ins, so if they will pay less no need of bill secondary?

Do you understand how COB works?

 

[yanyos]

Do you understand how COB works?

Yes!! But I want to know or have an example of a case so I can show to my coworkers.

Is there a (formula) to use or do I just need to see the rates to be able to understand how much the secondary will pay if it was primary and the decide if we need to bill or not? I search all internet and nothing appears in a clear way.

 

[somarco]

There is no formula per se. In general, the secondary payer reviews claim as if they were primary, then subtracts out what the primary paid.

If they would pay $500 and primary paid $550, secondary pays $0.

If primary paid $450, secondary pays $50.

I NEVER tell clients how claims would be paid. NEVER.

 

[yanyos]

There is no formula per se. In general, the secondary payer reviews claim as if they were primary, then subtracts out what the primary paid.

If they would pay $500 and primary paid $550, secondary pays $0.

If primary paid $450, secondary pays $50.

I NEVER tell clients how claims would be paid. NEVER.

Thank you, why is so confusing for billing department? ABA is more complicated or is something not easy to identify? In this case they don't like to bill the secondary if not necessary and that's why they want to know how to identify this. Thanks

 

[somarco]

Can't say.

My wife was in the hospital late January. Her group plan is primary, Medicare A is secondary.

Took almost 3 months for the hospital to bill. I suspect they were waiting on Medicare since BX paid in a couple of weeks.

In your case it may not be the provider having trouble billing, but the secondary carrier will normally take several weeks to adjudicate the claim.