Overview
If a patient has two insurance plans, ChiroHD requires a specific order of operations to bill the secondary correctly.
Skipping any step can result in:
Claim rejections at the clearinghouse
Balances that won't settle correctly
The patient disappearing from the Process EOB screen
This article walks through the full secondary billing workflow from start to finish.
Step 1: Confirm Secondary Coverage Is Set Up on the Patient's Case
Before creating any claims, verify the patient's secondary insurance is added to their case and marked correctly.
Navigate to the Patient Profile, Cases, Insurance / Coverage
Review the coverage table and check the Priority column — you should see both Primary and Secondary listed.
If the secondary insurance is missing:
Click Add New Insurance/Coverage.
Enter the plan information.
Under Priority, select Secondary.
Save.
NOTE: While navigating the Process EOB screen, you'll see a snapshot of each patient's coverage. Patients with only primary coverage will look different from those with both — keep this in mind when posting EOBs.
Step 2: Create and Send the Primary Claim
Navigate to Insurance, Create Claim.
Under Responsible Payer, select Primary.
Check the claim you would like to send.
Click Create Claim.
Click Send to Clearinghouse.
Please see our other resources on our Clearinghouse Integration and who we have integrations with.
Step 3: Post the Primary EOB
Navigate to Insurance Dashboard, then choose your posting method:
Posting with ERA file:
The ERA will appear on the Insurance home dashboard. ChiroHD pre-fills payment and adjustment fields automatically from the electronic remittance file — review and post from there.
Please see our other resources on Processing ERAs if you have further questions.
Manual Posting:
Click Process EOB, enter the third-party payer, and fill in all values line by line directly from the EOB.
You must complete the following fields for every line item:
Payment amount
Deductible
Co-pay
Coinsurance
Adjustments (e.g., contractual write-offs shown on the EOB)
Fill in the adjustment fields, but do not write off the remaining balance. These are two different actions in ChiroHD:
Adjustment fields (contractual write-off, deductible, co-pay, coinsurance) capture what the primary payer already reduced the claim by. These must be entered so the secondary claim file has the correct math. If the primary EOB shows a $40 contractual adjustment and you don't enter it, the secondary payer will see a claim where the math doesn't add up.
Writing off the remaining balance is a separate action that tells ChiroHD the service is fully settled with no further payment expected. Do not do this yet — the secondary EOB still needs a balance to post against.
If you write off the balance now, the patient will disappear from the Process EOB screen when you go to post the secondary. To fix it, you would need to go to the patient's ledger on the date of service and manually edit the line to restore an insurance balance — a lot of unnecessary extra steps.
Only write off remaining balances when posting the final (secondary) EOB.Once all line items are entered, click Finalize.
Please see our other resources on Processing an EOB from a Primary Payer.
Step 4: Create the Secondary Claim
Navigate to Insurance, Create Claim
Under Responsible Payer, select Secondary.
If the patient doesn't appear, confirm:
The date range includes the date of service
The primary claim has been created
The primary EOB has been posted
Check the claim you would like to send.
Click Create Claim.
The next step depends on who the primary payer is:
Step 5: Post the Secondary EOB
Navigate to Insurance, then choose your posting method:
ERA file: It will flow into the Insurance home screen automatically.
Manual entry: Click Process EOB, enter the third-party payer, and fill in the check amount.
When reviewing line items:
The Type column predicts which payer is responsible — update it if needed.
The Previously Paid column shows any amounts already posted from prior EOBs (e.g., the primary payment).
Once you've entered the secondary payment:
If the secondary payer indicates the patient has no remaining responsibility, you can now write off the remaining balance — use the W hotkey.
Click Finalize when done.
Verifying the Result
To confirm both payments posted correctly:
Navigate to the patient's Transaction History, Insurance History tab.
You'll see both the primary and secondary payer listed with their payment dates and amounts.
Restarting the Billing Process (Set to Rebill)
If you need to rebill a service, go to the patient's ledger, click Set to Rebill, and save.
Important: Set to Rebill resets both primary and secondary. You will need to go through the full workflow — primary claim, primary EOB, secondary claim, and secondary EOB — from the beginning.
If you have further questions on how to set to rebill, please see our other resources on How to rebill a claim.
✅ Key Takeaways
Secondary coverage must be added to the case and marked as Secondary in the Priority column before creating any claims.
The primary EOB must be posted before you can create the secondary claim — this is the most common mistake seen in support tickets.
Fill in all adjustment fields when manually posting the primary EOB. Empty or incorrect values will cause the secondary claim to reject.
Do not write off the remaining balance when posting the primary EOB. Leave a balance so the secondary EOB has something to post against.
Medicare as primary typically auto-forwards to the secondary — create the secondary claim in ChiroHD for your records, but do not send it to the clearinghouse (unless it doesn't auto-forward).
Set to Rebill resets both primary and secondary — you'll need to go through the full workflow again.
📌 Conclusion
Following this sequential workflow in ChiroHD—confirming insurance setups, accurately posting primary payments, properly creating the secondary claim, and carefully recording all EOB details—ensures error-free secondary insurance billing. By not skipping any step and referencing the platform’s adjustment and verification features, you help safeguard against rejected claims and unresolved patient balances.