Coordination of Benefits: Oral Surgery
Determining Medical / Dental COB Through Insurance Verification
August 2023
Coordination of benefits (COB) refers to the process insurance companies use to decide how much and in which order each plan will pay for covered services when a patient has coverage with more than one policy. Today, we’ll look specifically at oral surgery which often, and uniquely, can be covered by a both a patient’s medical and dental plans.
Determining medical/dental COB for oral surgery is short and sweet – it hinges on a clear, consistent insurance verification process!
Creating an effective insurance verification process is its own blog topic (coming soon) but here it is in a nutshell: Consistency is key. Standardize your verification process so all staff execute the same tasks, the same way. Gather the same verification data for medical and dental polices for all patients, ideally 2-4 weeks out in your schedule.
And while much of the verification data you need is available online, there are essential questions for each insurance that can often only be obtained with a phone call especially when it comes to coordinating medical and dental for oral surgery. Here are a few examples:
Oral Surgery - Dental Verification:
Is medical or dental primary for oral surgery?
Does dental require a medical EOB?
Oral Surgery - Medical Verification:
Is there oral surgery coverage?
Is medical primary for oral surgery?
Once comprehensive verification information is gathered for each patient for both dental and medical insurance, COB is easy and the primary/secondary billing order of each policy can be managed by your practice management software. Whenever possible, use electronic attachments to send the primary explanation of benefits (EOB) with your claim submission to the secondary policy. Read our blog on insurance payer ID’s to learn about electronic submissions and attachments.
Finally, when posting payments and write-offs for patients where multiple polices have processed claims for their services, please be advised of the best practice and ADA recommendation that write-offs should not be posted until all plans have paid accordingly. Moreover, with the rise of technology-driven claims processing, the burden of ensuring a denied claim has been adjudicated correctly often requires provider review and follow-up.
Stay tuned for our upcoming blog on insurance verification workflow. And in the meantime, to learn more about ADA Guidance on Coordination of Benefits, including managing dual dental policies, please visit: https://www.ada.org/resources/practice/dental-insurance/ada-guidance-on-coordination-of-benefits.
Need help determining medical/dental benefits for oral surgery? Dental Billing & Consulting Professionals provides tailored consulting services to meet your specific needs. Call or text us any time at (860) 435-7344 and our initial conversation is always at no charge.