Understanding coordination of benefits (COB) in dental insurance is crucial for ensuring patients receive maximum coverage, and your office receives maximum reimbursement without unnecessary delays or denials. Here are some essential dos and don'ts to streamline the COB process:
Dos:
1. Provide Accurate Information: Collect complete and accurate insurance details from patients, including any secondary or tertiary plans they may have. This ensures the correct order of benefits is determined for timely processing. Most of the time, the birthday rule applies, but in some instances it does not.
2. Verify Coverage: Confirm coverage with all applicable insurance carriers to determine the primary and secondary plans. Understanding COB rules, such as the birthday rule or non-duplication of benefits, helps in maximizing reimbursement.
3. Submit Claims Promptly: Timely submission of claims to all relevant insurance carriers expedites the COB process. Ensure claims are filed within designated time frames to prevent delays and maximize benefits.
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Pro Tip: Timely submission does not mean file to more than one insurance simultaneously - in fact, this should never be done. Secondary should not be submitted until primary has paid, so that the primary EOB can be submitted, and secondary will then coordinate the remainder of the payment accurately.
Don'ts:
1. Assume Primary Coverage: Avoid assuming which insurance plan is primary without verifying COB rules for each patient's coverage. Incorrect assumptions can lead to billing errors and claim denials. As mentioned in the “do” section - the birthday rule often applies, but can not be assumed.
2. Double-Billing: As mentioned in our pro tip: Refrain from submitting duplicate claims for the same services to multiple insurance carriers. Double-billing can result in accusations of fraud and damage the practice's reputation.
3. Neglect COB Guidelines: Familiarize yourself with each insurance plan's COB guidelines and ensure compliance to prevent claim denials and delays. This includes sending primary EOB’s with secondary claims.
For additional help navigating COB terminology and rules, we recommend a full review of the American Dental Association’s guidance on coordination of benefits
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