Entering Adjustments when Primary and Secondary are in Network

Dealing with primary and secondary insurance can be confusing when the office is a participating provider for both plans. Errors are routinely made when entering insurance payments in this situation. Recently Christine Taxin, shared an easy to understand process that I'm confident will be helpful for many practices.

1. When filing Primary and Secondary insurance, you MUST bill your full fee on the patient's ledger.
   
   
2. Submit Primary claim and Secondary Claims.
   
   
3. The patient is responsible only for the fee up to the lower of the two insurances. 

• • For example, if the fee for a crown is $700 from one insurance company and $800 from the other, then the patient is responsible for his/her portion only up to the lower fee of $700. If the office receives $700 or more from both insurances, then the patient owes nothing.
    
    
  • The office is ALLOWED to collect up to their office fee.
    
    
  • If the office receives more than their office fee, they must refund to the insurance company.
    
    
  • The patient does not collect any portion of the fee received by the office.

If you find that your patients with secondary insurance often have a large credit balance, you need to make sure your team is properly trained on this topic. Dental Insurance Navigator is an online program provides team training in all areas of insurance.