Secondary Claims Tool (Apex)

Apex's Secondary Claim Tool is designed to help you create secondary claims by guiding you though the steps in the secondary claims submission process, auto-populating applicable primary claims information, and calculating adjustment amounts, adjustment codes and payments associated with each service line on the claim. 

When the Secondary Claim tool is added to your account, you can access the tool for any claim that has been sent to a payer by selecting Prepare Secondary from the Action drop-down list. You will also be able to search for claims that are ready for secondary claim processing or have already been processed as secondary claims.

Submit a Secondary Claim with the Secondary Claims Tool

1. Click the Action button next to any claim that has been sent to a payer.
2. Select Prepare Secondary from the drop-down list. 
   
   
   
3. The Secondary Claim Status Tool Opens.
   
   • Important information about the primary claim displays at the top.
   • To exit the secondary claims tool and return to the OneTouch website, click the blue Claim Status link at the top. Any data you entered will not be saved if you exit the secondary claims tool before finalizing and submitting the secondary claim. 
   
   
   
   
4. Fill in Payer Name and Payer Address, then click the Next button.
   
   • Payer Name or Address information provided on the primary claim that is associated with the Other Subscriber will pull in automatically.
   • If no Other Payer information information is available on the primary claim, you can manually enter the Payer name address, or use the Search for Existing Payer field to select a payer from the Apex payer list by searching for the name or Payer ID.
   • Fields highlighted in red are required.
     
5. Select an option from the Who is the Secondary Subscriber? drop-down list.
   
   • If the secondary and primary subscribers are the same person, select Primary Claim Subscriber.
   • If the secondary subscriber and the patient are the same person, select Patient. 
   • If the secondary subscriber is someone someone different, select Other. 
   • Any applicable information from the primary claim will automatically populate in the proper fields. You can manually enter information that does not pull in from the primary claim. 
   • Missing required fields will be highlighted in red.  
     
     
     
6. Enter the Secondary Subscriber ID, then click the Next button.
   
   • If the secondary and primary subscribers are the same person, the Secondary Subscriber ID field will not auto-populate from the primary claim. The secondary subscriber ID is rarely the same as the primary subscriber ID. 
     
     
     
7. Review and edit Service Lines as needed. Once all service lines are balanced, click the Review and Finalize button. 
   
   • Adjustment amounts, adjustments codes and payments auto-populate for each service line based on electronic EOBs. 
     
   • Click on any service line to review or change adjustment amounts, adjustments codes and payments.
   • All of the adjustment and payment dollar amounts must sum to the total amount charged for each service line. If the dollar amounts do not balance there will be a notification in the Line Errors column. 
     
     
     
8. Review the claim, then click Submit Claim to finish and submit your secondary claim. 
   
   • If you need to make changes, click the Prev button to return to the previous screen where you can edit the service lines as needed. 
     
     
     
9. The Congratulations message indicates your secondary claim was submitted successfully. 
   
   • Apex will notify you of any validation errors you need need to fix before your claim can be submitted. 
   • Once your secondary claim has been submitted, you can view it on the Claim Status page.