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.