Patient called this morning to say that she is covered under 3 different insurance plans. I have no idea how to set up a third plan. Is it possible? If not, should I advise patient to file the 3rd plan themselves when they receive EOB's from primary and secondary? Thanks!
If you are Contracted with the Tertiary plan directly or indirectly via a Third Party Admin/ Umbrella plan you must file the claim for patient. If you are not contracted, you do not have to file.
Step 1.) Add the holder of the Tertiary plan under the next available Guarantor in the Account.
Step 2.) Assign relationship under Yellow Insurance tab on pt screen. ( you will not be allowed to assign tertiary dental insurance to the left of Pt Relationship section -YET)
Step 3.) Due to limitations of ADA form only two plans may be reported at one time. File Primary and secondary in the usual fashion. After completion of Secondary payment- DO NOT COMPLETE the Claim. , you can now submit electronically by following these steps: a.) Notate used amounts and effective dates shown for Prime and Second in contact screen. b.) go to the Yellow Ins tab in pt screen. Change the Primary plan for pt to that of their tertiary plan. the claim is now ready to submit to "primary". c.) Go to claim and select " Submit Primary" - SD will then tell you that some of the Insurance data has changed, do you want to use new information? Select YES . d.) Create NEA attachment and select EOB's of Prime and Second from Doc tree ( EOB's) or scan/add into NEA via NEA claim options. e.) Once completed, go back to the Ins Tab of pt screen and reenter Prime and Second plans, effective dates and remaining maximums.
NOTE: The details for the tertiary claim are exclusive to that claim. You do not need to repeat the steps above if the tertiary needs to be resubmitted. You simply have to select " NO" when asked if you want to change the insurance data for claim (as you would have reverted back to Prime & Second initial data for other claims and estimations) Selecting NO will keep the tertiary information on the claim for you.