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Coordination of Benefits (COB): Untangling the Mystery
Coordination of benefits (COB) is a common source of frustration for dental offices trying to submit claims when a patient presents with more than one dental plan. Because plans will coordinate benefits to eliminate over payment or duplication of benefits, to level the playing field, dentists want to know:

• When both payers claim their plan is secondary, how is the primary carrier determined?
• What fee can be charged – primary or secondary?
• What processing policies are followed?

The American Dental Association has recognized the need to educate dentists and dental offices on the administrative practices and policies of third party carriers including COB. With the dominance of preferred provider organization (PPO) plans in the market and since many families have more than one dental plan the need for dental offices to correctly coordinate benefits is of the utmost importance. It is vital that the ADA educate dental offices and provide relevant information on how to understand and properly coordinate benefits. Offices that are fluent in coordinating benefits will be able to better minimize claim adjudication issues when patients present with more than one dental plan.

Dentists will gain a basic understanding of why plans must coordinate benefits and how this may affect front office staff. A Council on Dental Benefit Programs member will echo concerns of other dental offices that have had issues with coordinating benefits. Also, a large dental insurance carrier will explain how coordination is handled and what dental offices must do to properly submit claims requiring COB.

1 CERP credit.

The ADA is a CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

Oct 26, 2021 12:00 PM in Central Time (US and Canada)

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Dr. Daniel Croley
Vice President and Chief Dental Officer @Delta Dental Plan of California
Daniel W. Croley, DMD, is vice president and chief dental officer for Delta Dental of California and its affiliated companies. He is responsible for building and maintaining a culture of high-quality oral health care to ensure the continual delivery of exceptional care to the customers, members, and communities proudly served throughout 15 state and three territory enterprises. Dr. Croley, who joined Delta Dental of California in 2004, is responsible for clinical vision and overall quality of oral health care for Delta Dental. He is deeply involved in product and service development and represents Delta Dental in many industries and professional organizations, including committees at the American Dental Association, National Association of Dental Plans, California Association of Dental Plans and Delta Dental Plans Association. Dr. Croley is a graduate of the University of Kentucky College of Dentistry in Lexington and completed a general practice residency at the Veterans Administ
Dr. Gene Porcelli
Executive Director, Nassau County Dental Society @ADA Council on Dental Benefit Programs
Dr. Porcelli is a 1983 Graduate of Georgetown University School of Dentistry in Washington DC and has practiced general dentistry for 38 years. Besides being a life member of the Tripartite, Dr. Porcelli is also a fellow in the Pierre Fauchard Academy and the International College of Dentists. He has been a member and chair of the New York State Dental Association’s Council on Dental Benefits for the last 14 years and a member of the ADA Council on Dental Benefit Programs since 2018. Dr. Porcelli has held numerous positions at every level of the Tripartite and is currently the Executive Director of the Nassau County Dental Society.
Dennis McHugh
Manager, Third Party Payer Advocacy @American Dental Association
Dennis McHugh is the manager of third party payer advocacy for the American Dental Association and works in the Practice Institute’s Center for Dental Benefits, Coding and Quality (CDBCQ). CDBCQ is the ADA agency responsible for promoting resources and information on dental benefit plans to employers and member dentists. In addition, CDBCQ responds to requests and helps resolve problems from member dentists regarding concerns with the CDT Code. He has been with the ADA for 21 years and prior to that spent 7 years working for the American Association of Orthodontists. Dennis graduated from Southeast Missouri State University with a Bachelor of Science degree in Business Administration and an Associate of Applied Science in Computer Science.