Overview
Processing a Medicare case when a secondary insurance is also involved follows a slightly different workflow compared to standard insurance cases. This guide will walk you through each step from start to finish, including tips for handling common errors.
Step 1: Setting Up the Patient Case
Create a Medicare Case:
Navigate to the patient's profile via search or the calendar.
Click Cases → Create New Case → select Medicare as the case type.
Important: Only use the "Medicare" case type if the payer is the U.S. government-issued Medicare (not Medicare Advantage or replacement plans — those use the standard "Insurance" case type).
Add Diagnosis Codes:
Enter diagnosis codes under the Treatment/DX tab.
Adjust start dates if necessary.
Add Primary and Secondary Insurance Policies:
Click Add New Insurance.
Set Medicare as the Primary.
Add the secondary insurer (e.g., Blue Cross Blue Shield) and set it as Secondary.
Fill in all required policy details accurately.
Attach Fee Schedules and Default Services (Optional):
If using fee schedules, attach it under Defaults.
If services are consistent per visit, add Default Services with modifiers as necessary (e.g., Medicare adjustments often require an
ATmodifier).
Step 2: Adding Charges and Submitting the SOAP Note
Once the patient arrives, the doctor will create a SOAP note.
Default services will automatically populate charges if set.
After finalizing the SOAP note, the charges appear in purple on the ledger (indicating they are unbilled).
Step 3: Creating the Medicare Claim
Go to: Insurance → Create Claim.
Find the Patient:
Uncheck Batch Billing unless you're submitting multiple patients.
Select the correct services.
Send the Claim:
Send to Clearing House (if SFTP credentials are configured)
ORDownload the Electronic File and manually upload it to your clearing house
ORPrint and Mail the HCFA 1500 form.
Note: Sending the claim to the clearing house is a manual step even though you’ve created the claim in ChiroHD.
Step 4: Posting the Medicare EOB
Go to: Insurance → Process EOB.
Enter Medicare Payment:
Select Medicare as the payer.
Enter check details and payment amounts.
Assign co-insurance amounts properly.
Do not write off any remaining balance yet if a secondary insurance exists.
Finalize the EOB Posting.
After posting, the services will show blue (partially paid).
Step 5: Handling the Secondary Insurance and Medicare Auto-Forwarding
Medicare Autoforwarding and What that Looks like in ChiroHD
Medicare will auto-forward the claim to the secondary payer.
However, ChiroHD does not automatically recognize this. You must clear or ghost bill the secondary claim manually.
How to Show the Secondary Claim as Billed:
Go to: Insurance → Create Claim.
Switch Responsible Party to Secondary.
Select Only the Relevant Patient.
Click Create Claim.
Do not send it again via clearing house.
Optional: Add a memo like "ghost bill" or "clearing queue" for clarity.
Step 6: Posting the Secondary EOB
Go to: Insurance → Process EOB.
Select the Secondary Payer (e.g., Blue Cross Blue Shield).
Post Payment:
Apply any payments from the secondary.
If the secondary covers previously listed co-insurance amounts, update fields accordingly.
Zero out patient co-insurance if secondary covers it.
Finalize Posting:
If this is the last insurance, you can now write off any remaining balance if you choose to do so.
After posting the secondary EOB, the lines on the patient's ledger should appear green (fully settled).
Troubleshooting Common Issues
If you mistakenly wrote off a balance when posting the primary EOB:
Go to the patient’s ledger.
Edit the service line (using the second edit button under "Billed").
Remove the write-off and save.
This recreates an insurance balance allowing you to post the secondary EOB.
If the secondary policy wasn’t entered initially:
Add it as soon as possible.
Clear the claim through the secondary queue before attempting to post the EOB.
Final Reminders
Do not write off remaining balances until all insurances have responded.
Always clear the secondary queue even if Medicare has forwarded the claim.
Create and post EOBs in order: Primary → Secondary.
Use clear labeling ("ghost bill" or "clearing queue") to track when Medicare forwards a claim.