<p>UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY UNIVERSITY EYE INSTITUTE</p><p>CLINIC BUSINESS OFFICE • POLICY 30.0 February 15, 2008</p><p>Primary and Secondary Insurance Claims</p><p>It is the policy of the University Eye Institute to submit clean claims to third-party payers in a timely manner as a courtesy to patients and in an effort to receive prompt payment for services rendered.</p><p>PROCEDURES</p><p>1. Prior to submitting claims, charges are reviewed automatically or manually for accuracy. </p><p> a. Every effort is made to eliminate errors in registration, procedure, and diagnosis coding and charge entry to ensure timely reimbursement.</p><p> b. During the review process, any discrepancies are resolved immediately. </p><p> c. If necessary, the clinic rendering the service for which the charge is being billed is contacted in person or an internal e-mail communication regarding the charge. </p><p> d. Charge edits are resolved in four business days. </p><p>2. Following the edit process, clean claims are sent electronically real-time or by the end of the business day. </p><p>3. Exception reports generated from the submission are worked on a same-day basis. </p><p>4. Claims are not suspended unless absolutely necessary. </p><p>5. The Clinic Business Office submits secondary claims in the event that a patient maintains a secondary insurance policy and the primary insurance carrier does not pay the full amount of the charge. </p><p> a. The secondary insurance carrier is billed for the remainder of the balance. </p><p>95 b. The Clinic Business Office makes best efforts to work with payers to crossover secondary claims automatically. </p><p> c. If not, the primary explanation of benefits (EOB) is flagged manually or electronically, and submitted to a Clinic Business Office to bill the secondary insurance carrier. </p><p> d. Within 24 hours of notification of responsibility of the secondary payer, the secondary claim(s) are submitted. </p><p>7. The full balance of primary and secondary claims submitted to third-party payers with whom the The University Eye Institute does not participate are transferred to patient responsibility at 45 days, or another time period that the business office designates. </p><p>96</p>