How to Submit Secondary Claims as a Mental Health Therapist
If you’re a behavioral health therapist who accepts insurance, you’ve probably encountered clients with both primary and secondary insurance coverage. While submitting claims to a primary insurer might already be part of your workflow, submitting secondary claims can feel more complex—but it’s also a vital part of getting fully reimbursed for your services.
In this blog post, we’ll explain:
- What secondary insurance and claims are
- How they differ from primary claims
- How to establish a client’s secondary coverage
- A step-by-step guide to submitting secondary claims
- Common tips and pitfalls to avoid
Let’s break it down so you can confidently get reimbursed for the full value of your services.
What Is Secondary Insurance?
Secondary insurance is an additional insurance plan that a client holds to help cover the costs not paid by their primary insurance—such as copayments, coinsurance, or deductibles. For example, if your client is a child with divorced parents, one parent’s policy may be listed as the primary insurer, and the other as the secondary. Or if your client is retired, they may have Medicare as their primary insurance and a supplemental plan (like a Medigap policy or Medicaid) as their secondary.
The Role of Secondary Insurance:
- Pays after the primary insurer has processed the claim
- May cover what the primary insurer doesn’t pay
- Requires an Explanation of Benefits (EOB) from the primary payer to determine remaining responsibility
Primary vs. Secondary Insurance: Key Differences
| Feature | Primary Insurance | Secondary Insurance |
|---|---|---|
| Order of Processing | Always billed first | Billed only after primary has paid or denied |
| Determines Allowed Amount | Yes | Uses primary’s allowed amount to calculate payment |
| Needs EOB from Primary | Not required to submit | Always required |
| Provider Reimbursement | Often partial (with deductible/copay) | May cover remaining balance |
Understanding this hierarchy is essential because submitting to secondary without first getting a primary EOB will result in a denial.
Step 1: Establish Secondary Coverage at Intake
The best way to ensure clean claims is to gather complete and accurate insurance information upfront.
If you need help with this or following steps, we encourage you to explore partnering with a behavioral health biller who can ensure you set everything up accurately from the beginning. (One of our favorites is Practice Solutions)
Here’s what to do:
- Ask for both insurance cards and photocopy or scan front and back
- Verify eligibility and coordination of benefits by calling both insurers or using your clearinghouse’s eligibility tools
- Confirm which plan is primary vs. secondary, especially in cases with:
- Two working parents (the birthday rule may apply)
- Divorce (legal documents may determine responsibility)
- Medicare + another plan
- Enter both payers in your practice management or EHR software, in the correct order
✅ Pro tip: If the secondary plan is Medicaid, check for any restrictions on which services it will cover as a secondary (some state plans may not cover all therapy codes).
Step 2: Submit the Claim to the Primary Insurance
Your first step in the billing process is to submit the claim to the primary payer:
- Create a standard CMS-1500 claim form.
- Make sure the client’s subscriber and diagnosis info is accurate.
- Submit the claim through your billing software, clearinghouse, or payer portal.
- Wait for the Explanation of Benefits (EOB) or 835 electronic remittance.
The EOB will detail what was paid, what was applied to deductible, and what the patient still owes.
Step 3: Prepare the Secondary Claim
Now that you have the EOB, it’s time to prepare the claim for the secondary insurance. Most clearinghouses or EHRs will allow you to forward the original claim along with the EOB to the secondary payer—but you can also submit it manually.
When submitting electronically:
- Use the same claim form used for the primary.
- Include the primary EOB or 835 payment file.
- Make sure your software tags this as a secondary claim using payer-level codes.
When submitting on paper:
- Include:
- CMS-1500 form
- Copy of the EOB from the primary
- Any patient responsibility documentation
Important fields to double-check:
- Field 11d (CMS-1500): Mark “Yes” for other insurance
- Field 9 & 9d: Include secondary insurance details
- Field 29: Total amount paid by primary insurer
✅ Reference: CMS-1500 Claim Form Instructions (PDF)
Step 4: Track and Follow Up
Just like with primary claims, don’t assume your secondary claim was processed correctly—track it! Use your billing system or a simple spreadsheet to note:
- Date submitted
- Date acknowledged by clearinghouse
- Date paid or denied
- Any reasons for denial
If the secondary denies the claim due to “missing EOB,” it’s likely something wasn’t attached or parsed correctly. You may need to resubmit with additional documentation.
Common Scenarios and Tips
What if the primary pays 100%?
If the primary covers the entire allowed amount, you may not need to submit to the secondary. But some secondary plans still want a record, especially Medicaid.
What if I’m out-of-network with the secondary?
Secondary payers may deny claims for out-of-network providers. Be upfront with clients about this during intake.
Do clients ever get reimbursed directly?
If you’re not credentialed with the secondary insurer, the check may go to the client. Make sure they understand this possibility.
Automating the Process
Submitting secondary claims doesn’t have to be manual or tedious. Modern behavioral health EHRs—like CheckpointEHR—often integrate clearinghouses that can:
- Forward EOBs automatically
- Route claims directly to secondaries
- Flag issues before submission
Be sure to check if your system supports electronic secondary claim submission (COB automation).
Final Thoughts
Submitting secondary insurance claims is a vital part of maximizing your revenue as a mental health provider. While it can add a layer of administrative complexity, having a clear process makes it manageable. By:
- Verifying insurance early,
- Tracking EOBs,
- Using the right fields in your CMS-1500,
- And using software that automates coordination of benefits,
…you’ll save time and increase the likelihood of full payment.
Want a System to Track Claims Across All Payers?
If you’re finding it hard to manage all your claims—primary, secondary, and beyond—it may be time to level up your behavioral health EHR. Having an electronic health record system that can handle complex, behavioral health billing needs is imperative to the sustainability of your practice.
That’s where CheckpointEHR comes in!
Our platform is here to help you simply, automate, and maximize all of your mental health insurance processes to maximize practice revenue.
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