When a patient has two insurance plans, managing the open dental coordination of benefits process is often where billing errors occur. If you fail to correctly link the primary payment to the secondary claim, you risk under-collecting from the patient or having the secondary carrier deny the claim entirely due to missing primary EOB information.
Before You Start
Before you begin, ensure your practice management setup is correct to avoid data entry headaches:
- Verify Insurance Plans: Ensure both the primary and secondary insurance plans are entered correctly in the Family Module. The secondary plan must have the "Coordination of Benefits" settings configured correctly (usually set to "Standard" or "COB" depending on the carrier's requirements).
- Patient Eligibility: Confirm that the secondary insurance is active and that you have the correct subscriber ID and group number.
- Clearinghouse: Ensure your clearinghouse is configured to handle secondary electronic claims, as some carriers still require paper attachments for primary EOBs.
Step-by-Step Instructions
Follow these steps in the Account Module to process a secondary claim after the primary insurance has paid.
- Receive Primary Payment: In the Account Module, locate the primary claim. Double-click it to open the Edit Claim window. Click "Receive Payment," enter the payment details, and ensure the status is set to "Received."
- Create Secondary Claim: With the patient selected in the Account Module, click the dropdown arrow next to the "New Claim" button and select "New Secondary Claim."
- Configure Secondary Claim: The Edit Claim window will open. Verify that the "Claim Type" is set to "Secondary."
- Attach Primary EOB: Navigate to the Other Ins Info tab within the Edit Claim window. Here, you must indicate that the primary payment has been received. If you are sending electronically, ensure the primary payment amount is reflected in the "Pri. Paid" field.
- Set Status: If you are waiting for the primary payment to post fully or need to attach a document, you may set the status to "Hold until Pri Received." Once ready to bill, change the status to "Waiting to Send."
- Submit: Click "OK" to save the claim. When you are ready to transmit, go to the Manage Module > Send Claims to batch and send the secondary claim to your clearinghouse.
Common Mistakes
- Forgetting to link the Primary Payment: If you create the secondary claim before the primary payment is marked as "Received" in the Edit Claim window, the secondary claim will not show the primary insurance's contribution, leading to an automatic denial for "missing primary payment information."
- Incorrect Claim Status: If you leave a secondary claim in "Waiting to Send" status indefinitely, it will not appear on your Outstanding Insurance Claims Report, causing you to lose track of potential revenue.
- Not using the "Supplemental" button: If you receive an additional payment on a claim that was already marked "Received," do not edit the original payment. Instead, open the claim and use the "Supplemental" button to add the additional funds correctly.
Related Scenarios
If you need to see which claims are currently pending or unpaid, use the . If you are struggling with claims that haven't been sent yet, check the to identify missed billing opportunities.
Track all your outstanding claims at a glance with DentalCanvas — a visual dashboard that shows your insurance aging, pending claims, and collection trends in real time.
This article is provided by opendentalsupport.com, an independent community resource. We are not affiliated with Open Dental Software, Inc.