Submitting Secondary Claims with Other Health Insurance through Electronic Data Interchange
Providers submitting claims through electronic data interchange (EDI) can submit TRICARE secondary claims in the HIPAA-compliant 837 professional format. Submitting other health insurance claims through EDI will eliminate the need to send an Explanation of Benefits from the primary insurance.
The following coding must be used:
SBR01 = P (primary payer)
AMT01 = D
AMT02 = primary payer paid amount
Note: If AMT02 = 0, then CAS02 should have the Claim Adjustment Reason Code (CARC) from HIPAA Implementation Guides for nonpayment by primary insurance.