Sunday, February 6, 2011

Dental office help with Primary and Seconday insurance?

I just started working in a dental office with no experience and the girl who is training me is not doing a good job, hell when I ask her a question she won't even look at me. Therefore I am coming on here for some help. I use the program tracker and when the clients come in for thier appointment we send thier claim electronically to the insurance company. The EDI then says that it's been approved and then they pay the money for thier appointment. I get confused when it comes to primary and seconday insurance. Last week a client came in and I put his claim through to his insurance. It said claim was under review and he also had secondary insurance. what does it mean when it says the claim is under review. Do I have to wait till he gets the cheque from his insurance to see how much they covered and then send in the seconday insurance paper. Please help me out if anyone knows how to help me. Thank you
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we cannot speculate here why there is a review as we have no clue how the claim was submitted, so we do not know exactly what they are looking at. the claim is submitted to the primary carrier. they make their determination (apply to deductible, pay, or deny), and any outstanding balance is then submitted to the secondary insurance. they will do the same process as the primary carrier and make their determination. yes, you need to wait to see what the primary carrier will pay before you bill the secondary as you need to submit that information to the secondary carrier.
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