For non-crossover claims, the billing & coding specialist should prepare an additional claim for the secondary payer and send it with a copy of which document?

For non-crossover claims, the billing & coding specialist should prepare an additional claim for the secondary payer and send it with a copy of which document?

• A. Remittance advice
• B. Explanation of Benefits
• C. Payment ledger
• D. Medical record

Answer: (A)

When multiple payers are involved, the secondary payer needs to see how the primary payer handled the claim to determine what is still owed. The remittance advice from the primary payer provides the detailed payment information: what was paid, what was denied or reduced, the allowed amounts, and any patient responsibility. This document lets the secondary payer apply coordination of benefits correctly and adjudicate the secondary claim without reprocessing from scratch. An Explanation of Benefits is typically patient-facing and may not contain the payer’s internal adjustment codes or exact payment details used for COB. A payment ledger is an internal record, not the payer-supplied summary needed for COB. A medical record isn’t appropriate to send just to support a secondary claim. Therefore, including the primary payer’s remittance advice with the secondary claim gives the necessary, precise information for proper processing.

When multiple payers are involved, the secondary payer needs to see how the primary payer handled the claim to determine what is still owed. The remittance advice from the primary payer provides the detailed payment information: what was paid, what was denied or reduced, the allowed amounts, and any patient responsibility. This document lets the secondary payer apply coordination of benefits correctly and adjudicate the secondary claim without reprocessing from scratch.

An Explanation of Benefits is typically patient-facing and may not contain the payer’s internal adjustment codes or exact payment details used for COB. A payment ledger is an internal record, not the payer-supplied summary needed for COB. A medical record isn’t appropriate to send just to support a secondary claim. Therefore, including the primary payer’s remittance advice with the secondary claim gives the necessary, precise information for proper processing.