How to create a secondary/duplicate claim in Inovalon?

Purpose:

To guide users on how they can create a secondary/duplicate claim in Inovalon

PLEASE NOTE: Claim must be paid. Remit advice from primary payer will need to be entered in order to balance the PR amount due on the secondary claim, including any payer reductions. Download/access
primary RA for the claims you are pushing to secondary.

Procedure:

1. Locate primary claim in Inovalon. Select claim to modify it.
2. Scroll down to the insurances portion of the claim. The primary payer is listed on tab A.
3. Select the plus symbol next to the primary payer to add a secondary payer.
4. Select the B tab to enter info. Choose the field labeled “6 Patient Relate” and enter the
   patient code 18 for “Self”. This will cause the patient demographics to copy from the
   primary claim
5. Enter “Y” for yes in the “Release Info” and “Assign Benefits” fields.
6. Choose and save the secondary payer ID from the drop down menu in section 11c Payer
   Name & Address.
7. Enter the secondary member ID in the Subscriber ID field.
8. Select Save from the Transaction menu.
9. Select Yes to preserving the primary claim status (Paid, Ack, etc.)
10.  Once claim has been saved, select Replicate from the Copy menu.
11. Choose Yes to the prompt if you want to view the duplicate you created, choose no if you
    want to remain on the original claim. Your claim is now created and must be validated.

Validating and submitting your secondary claim: 

1. Locate and open your created claim
2. Select the B tab with your secondary payer name listed on it and select the “Make Destination
   Payer” green checkbox on the right.
3. Select the A tab with the primary payer name. Copy the “1a. Member ID” for the primary payer
   from the “4 Subscriber Name & Address” section. (Staplers added to cover redacted PHI)
4. Select the two small forward arrows on the right under the “Make Destination Payer” button.
   *Note: this tab now shows the “Make Destination Payer” button because you previously assigned
   the secondary payer as the destination payer in step (2.)*
5. In the Additional Insurance Information pop-up window, paste the member ID into the “National
   Plan ID” field.
6. Enter the Payment Date, Prior Payment, Allowed Amount, and Patient Responsibility from the
   primary RA.