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Canine III

Federal Dual insurance dental estimation

Most of our federal employees have plans the require that I send our claims first to their medical insurance and then to their secondary plan. Typically, the medical insurance pays for only preventative and diagnostic; my problem comes when I'm estimating for this type of patient. SoftDent won't adjust the network adjustment when applicable, so the patient portion has that showing on their estimate. 

I think it has to do with the primary insurance having 0% all the categories except preventative and diagnostic. I'm stumped. Anyone out there experience the same thing?

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Canine II

Re: Federal Dual insurance dental estimation

Yes what we do is figure the w/o by our allowance table and add it to the secondary payment.

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Premolar III

Re: Federal Dual insurance dental estimation

Softdent will not configure the Secondary's allowable ie, adjustment due to the fact that SD(and most other PMS) configure to whichever allowable is entered under the Primary plan.   Therefore, if there is not an adjustment on the primary plan, SD will not configure an adjustment at all.    

In this situation, I apply an adjustment to the tx plan based upon the secondary allowable.  I certainly hope that SD can fix this in future.   

TIP:   Save the FEHB plan brochure as an EOB in the account and pt doc tree.  This Brochure of allowances can be used as your Primary EOB in event of non-covered services, therefore, saving time waiting on a definite primary denial.  

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