When patients have multiple insurance plans, billing the wrong one first can lead to denied claims, payment delays, and frustrated patients. At Quick Claim Med, we know that proper coordination of benefits (COB) is critical for clean claims and faster reimbursements.
This guide breaks down how to identify primary vs. secondary insurance, avoid costly mistakes, and streamline your billing process.
Why Proper Insurance Order Matters
Billing the correct primary insurance first ensures:
✅ Fewer claim denials – Avoid rejections due to incorrect COB
✅ Faster payments – Prevent delays from reworking claims
✅ Patient satisfaction – Reduce surprise bills and confusion
✅ Maximized revenue – Collect what you’re owed without unnecessary follow-ups
Key Rule: If the primary insurance denies a claim, the secondary insurer typically won’t pay either. That’s why getting it right the first time is crucial.
Primary vs. Secondary Insurance: Key Differences
Feature Primary Insurance Secondary Insurance
Role Pays first – processes the initial claim Pays second – covers remaining balances
When It Pays Immediately after claim submission Only after primary pays its portion
Coverage Examples Employer plans, Medicare (in some cases) Spouse’s plan, Medicaid, supplemental policies
If Claim is Denied Must be resolved before secondary pays Typically denies if primary does
Example:
Total bill: $1,000
Primary insurance pays: $700
Secondary insurance may cover: Remaining $300 (depending on policy)
Step-by-Step Guide to Determine Primary vs. Secondary Insurance
1️⃣ Gather Complete Patient Insurance Details
Ask: “Do you have other active coverage?”
Collect both insurance cards (front & back—critical for COB details).
Verify:
Policyholder name (patient, spouse, parent?)
Coverage type (employer, Medicare, Medicaid?)
Effective dates (avoid billing inactive plans).
Pro Tip: Scan insurance cards into your EHR—many COB details are on the back.
2️⃣ Apply Coordination of Benefits (COB) Rules
Employer Plans:
Patient’s own employer plan = Primary
Spouse’s employer plan = Secondary
Dependent Children:
Birthday Rule: Parent with the earlier birthday month/day = Primary
Exception: Court orders may override this.
Medicare Scenarios:
If patient is 65+ and still working (employer with 20+ employees), employer plan = Primary, Medicare = Secondary.
Medicaid is always last (payer of last resort).
3️⃣ Verify COB with Payers
Never assume—always confirm with insurers via:
✔ Payer portals (Availity, Change Healthcare)
✔ Clearinghouse eligibility checks
✔ Direct calls to insurers (document rep name & reference #)
Sample Script:
“Can you confirm if [Plan Name] is primary or secondary for [Patient Name] as of [DOS]?”
Top Mistakes to Avoid
🚫 Assuming Medicare is always primary (it’s not—check employment status).
🚫 Billing Medicaid first (it’s always last).
🚫 Not checking policy effective dates (expired coverage = instant denial).
🚫 Skipping annual COB updates (divorces, job changes, Medicare eligibility can shift order).
Tools to Simplify COB Verification
Real-Time Eligibility Checkers: Availity, Experian Health
Payer Portals: UHC, Cigna, BCBS
Clearinghouses: Waystar, Change Healthcare
EHR Alerts: Flag patients with multiple plans for review
Need Help with COB? Let Quick Claim Med Handle It!
Don’t waste time untangling primary vs. secondary insurance. Our expert medical billing team ensures:
🔹 Accurate claim submissions (right payer, first time)
🔹 Reduced denials & faster payments
🔹 Full compliance with COB rules
📞 Contact Quick Claim Med [email protected] today for a free billing audit and let us optimize your revenue cycle!
