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Coordination of benefits and secondary insurance billing for therapy practices. Coordination of benefits logic for dual-coverage clients. Automatic secondary claim generation after primary adjudication.
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Coordination of benefits is where most therapy billing systems quietly lose money. MyTherapyWizard detects secondary coverage at eligibility time, classifies it as COB-IN or COB-OON based on the org's in-network list, and supports crossover claim submission from the same workflow as the primary.
When eligibility returns a secondary payer for a patient, MyTherapyWizard cross-references the secondary payer against the org_payers table, the org's configured in-network payer list. If the secondary is in-network, the flag is COB-IN. If not, COB-OON. Both flag types require admin review before billing; neither triggers automatic action. Admin can apply service stop or hold directly from a COB flag row. Default COB handling (e.g., 'always flag COB-OON for manual review before billing') is configurable per org.
For COB-IN patients, after the primary ERA is posted, MyTherapyWizard generates and submits a secondary claim to ClaimMD with crossover_id populated from the primary claim. No manual rebuild of the 1500 form, no separate portal login. COB flags surface in the Needs Action tab alongside auth alerts and unsigned notes, same flag architecture, same review workflow.
Product screens, workflow diagrams, and example outputs. Replace each slot with a real screenshot or illustration.
The technical architecture, API integration points, and data model that make this feature work the way it does.
org_id, payer_id, in_network boolean. Populated during org setup. After every eligibility response, MyTherapyWizard checks the returned secondary payer against this table. Flag type COB_IN or COB_OON is written to the flag record.
After the primary ERA is posted, admin confirms patient responsibility and initiates the secondary. MyTherapyWizard submits to ClaimMD /services/upload/ with crossover_id populated from the primary claim, standard X12 837P crossover semantics.
COB_IN and COB_OON flags use the same immutable, timestamped architecture as eligibility-change and service-stop flags. Admin creates a new action to override, originals are never edited.
Org settings include COB behavior preferences (e.g., 'always flag COB-OON for manual review before billing'). Respected by the Needs Action queue and the billing workflow.
COB-IN flagged automatically at eligibility. Crossover claim submitted to ClaimMD after primary posts. Secondary reimbursement collected on claims that would otherwise be adjusted to patient responsibility.
Out-of-network secondary payers flag for manual review before the primary even submits, so admin can price the service correctly or initiate a conversation with the family.
If secondary coverage changes mid-episode, admin can Stop, Hold, or mark Insurance Change from the flag. Propagates to the therapist worklist immediately.
Book a 30-minute walkthrough with our clinical team. We will show the exact workflow for your discipline and caseload.