Submitting secondary claims

Kaiser Permanente, along with other payers participating in the Washington Healthcare Forum, has agreed to accept secondary claims electronically with no explanation of benefits (EOB) as long as the appropriate electronic fields are populated. See the Worksmart Institute's Claims Processing Policies and Guidelines for how to submit electronic and paper claims.

Participating health plans will not require providers to submit paper EOBs with electronic secondary claims as long as the primary payer is a commercial insurance company and necessary EOB information is included with the claim.

With the exception of Medicare COB, Kaiser Permanente also will accept UB-04 and CMS 1500 paper claims without a paper EOB if these guidelines are followed in completing the paper claim.

Required claim fields for secondary billing

If you leave any of the following fields empty or blank on your claim, we will deny the claim.

Form locator (FL) for CMS-1500 claims

• 9, 9a, and 9d: Other Insured Information — insurance name, identifying number, and payer ID
• 10a and 10b: Auto accidents, personal injuries, and employment-related injuries
• 19: Note - Must contain COBZ or COB = Z if the primary health plan paid zero
• 21: E code to highest level of specificity describing the accident or injury in 10a and 10b
• 29: Must contain a dollar amount or zero
• 33a: Billing provider NPI field

Form locator (FL) for UB-04 claims

• 32: Auto accidents, personal injuries, and employment-related injuries
• 50a, 50b, or 50c: Payer name — primary, secondary, and tertiary
• 54a, 54b, or 54c: Must contain a dollar amount or zero
• 56: Pay-to provider NPI
• 58a, 58b, or 58c: Insured's name — required if other insurance or Medicare secondary payer
• 60a, 60b, or 60c: Insured's unique ID: Kaiser Permanente member ID number
• 77: E code to highest level of specificity describing accident
• 80: Note - Must contain COBZ or COB = Z if the primary health plan paid zero
• 81a-d: Billing Provider and miscellaneous NPI and taxonomy fields