This feature is currently in beta. Secondary claims are available to a limited group of customers while we gather real-world feedback and continue refining the experience. If you'd like to participate in the beta, join the beta group here.
When a patient has more than one insurance plan, you can bill the remaining patient responsibility to a secondary payer after the primary has paid. DocStation supports this through secondary claim creation and submission.
What is a secondary claim?
A secondary claim is submitted to a patient's second insurance plan to cover some or all of the patient responsibility left after the primary payer has adjudicated the original claim. This process is sometimes called Coordination of Benefits (COB).
Common examples include:
A patient with both a commercial plan and Medicaid coverage
A Medicare beneficiary with a supplemental Medigap plan
A patient whose employer plan is secondary to a spouse's employer plan
In DocStation, a secondary claim is linked to its primary claim and carries the prior payer adjudication details needed for the secondary payer to properly process it.
Creating a secondary claim
There are three ways to create a secondary claim in DocStation.
Option 1: From an existing claim on DocStation
Use this when the primary claim was already submitted and paid through DocStation.
Open the paid primary claim.
Click the ... (more options) menu in the upper right corner of the claim panel.
Select Create secondary claim.
DocStation will create a new claim in Draft status, tagged as Secondary. The Prior Payer Adjudication section will be pre-populated with details copied from the primary claim, including the paid amount, patient responsibility, adjudication date, and payer information.
Note: Review the Payer field on the secondary claim before submitting. DocStation will identify the secondary payer from the BIN data on the primary claim where possible, but you may need to select the correct payer manually if it cannot be resolved automatically.
Option 2: Manually, from the Add Claim flow
Use this when the primary claim was submitted outside of DocStation and you need to enter the prior adjudication information by hand.
Navigate to a patient's Claims tab.
Click Add Claim.
Select the appropriate claim template.
Check Create as secondary claim before clicking Create.
The claim will open in Draft status with the Secondary tag. You will need to fill in the Prior Payer Adjudication section manually.
Option 3: Via BIN billing (automatic)
If your dispensing system has DocStation's BIN set as the secondary third-party record on a prescription, DocStation will automatically detect the secondary COB data in the incoming claim and create a secondary claim for you. The claim will appear in Draft status for your review before submission.
Important: Even in this workflow, you will need to confirm that the correct payer is selected on the claim before submitting. DocStation displays the primary BIN as a reference, but the secondary payer must be identified and selected.
Filling in Prior Payer Adjudication details
The Prior Payer Adjudication section is what tells the secondary payer how the primary handled the claim. When you create a secondary claim from an existing DocStation claim, this section is auto-populated and marked Copied from Linked Claim. If you are creating the secondary claim manually, you will need to enter these fields yourself.
Field | What to enter |
Prior Payer | The primary insurance payer |
Adjudication Date | The date the primary payer processed the claim |
Total Paid | The amount the primary payer paid |
Patient Responsibility | The remaining balance after primary payment |
Patient Paid | Any amount already collected from the patient |
Prior Payer Subscriber ID | The patient's member ID with the primary payer |
Prior Payer Plan Type | The type of primary coverage (e.g., Medicare Part B) |
Prior Payer Relationship | The patient's relationship to the primary subscriber |
You can also add line-item adjustment details using the Procedure Code, Paid Amount, Allowed Amount, and adjustment Group / Reason Code / Amount fields. These correspond to the CARC/RARC codes from the primary remittance.
What gets billed on a secondary claim?
The amount billed on a secondary claim is the full charge amount from the primary claim â not just the patient responsibility. This is how the 837P standard works: the secondary payer uses the COB data in the Prior Payer Adjudication section (the primary paid amount, adjustment reason codes, and patient responsibility) to calculate what it owes. DocStation handles this automatically when the secondary claim is created from a linked primary claim.
The CARC (Claim Adjustment Reason Codes) and RARC (Remittance Advice Remark Codes) from the primary adjudication tell the secondary payer exactly how the original claim was adjudicated and what portion, if any, they are responsible for covering.
Submitting a secondary claim
Secondary claims follow the same submission workflow as standard claims. Once the claim is in Draft status and all required fields are complete:
Review the claim details to confirm everything looks correct.
Click the attestation button to confirm the information.
Click Submit Claim to send it to the secondary payer through the clearinghouse.
Status updates and remittance will appear on the claim when received.
Before submitting: Make sure a Payer is selected. A secondary claim cannot be submitted without a payer assigned. If the payer was not auto-populated, select it from the dropdown in the Plan Details section.
Finding secondary claims
Secondary claims are tagged with a Secondary badge in the claims list and on the claim detail panel. You can filter the claims list by secondary claims to find them quickly.
Frequently asked questions
Can I create a secondary claim from a claim that was submitted outside of DocStation?
Yes. Use Option 2 (Add Claim dialog with the "Create as secondary claim" checkbox) and enter the prior payer adjudication details manually.
What if the wrong payer is auto-selected?
Open the claim, go to the Plan Details section, and update the Payer field before submitting.
What does "Assigned at submission" mean on a secondary claim?
This status indicates the secondary claim is ready to be assigned to the clearinghouse at the time of submission. It will be transmitted when you submit the claim.
Can secondary claims be reversed?
Yes. Use the Reverse option from the claim's ... menu, the same way you would reverse any other claim.
Will DocStation track remittance from the secondary payer?
Yes. When the secondary payer returns an ERA (electronic remittance advice), it will be matched to the secondary claim and the claim status and paid amounts will update accordingly.
This feature is in beta. If you run into unexpected behavior or have feedback from real-world use, we'd love to hear from you. Reach out to your DocStation support contact or join the beta group to share what you're seeing.