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cjenkins
Canine III

COB info on secondary insurance claim

How are people electronically including COB info on the secondary claim form in WinOMS CS?  We have a medical insurance company that WILL NOT accept a form with handwritten information on it, yet CareStream support tells me that there is no way to have a medical claim form populate a primary insurance information (Boxes 9 a & d, 11 d).  Without these fields completed, the insurance processes as primary, yet it is a secondary plan.

14 Replies
CS Dental Employee
CS Dental Employee

Re: COB info on secondary insurance claim

Hello cjenkins@michiganoralsurgeons.com

Can you tell me more specifics about the insurances you are billing?

  • Do you bill dental or medical first?
  • how many of each (D or M) does the patient have?
  • Exactly what order are you billing the specific carriers/plans in question (let me know so that we can talk about them specifically)
  • Are we talking paper claims here or eClaims?  If paper claims, which format do you have selected for the problem plan?

In the meantime, I am running some basic tests to get a feel for the workflow, and I cannot duplicate the issue you report.  This is the secondary medical claim i generated just now: 

I can get correct insurance details to populate in the boxes you mention, so I will need a few more details here.

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cjenkins
Canine III

Re: COB info on secondary insurance claim

Hi Matt,

Here is the scenario.

A patient had impacted wisdom teeth removed which is covered by both his dental and medical insurance.

With this particular medical policy which is very common around here (teacher’s union), the claim must be billed to the dental insurance first, then billed to the medical insurance with the COB information on the claim form.

We currently do not have NEA attachments so we send the claim to the secondary medical on paper with the primary EOB attached.

We are using form 113 for this secondary claim to BCBS of MI.

I do not know how to make the primary dental insurance fill in properly on this form. I called support yesterday and they told me it was not possible.

We have a 2” thick file of claims that we can’t submit because BCBS will not accept them with handwritten information on them, we do not have a typewriter here to type in the information and we can’t get this to work within WinOMS.

If there is a way to do it I’ll be so happy!!!

Thank you,

Christi

Christi Jenkins

Operations Specialist/Surgical Coordinator

CS Dental Employee
CS Dental Employee

Re: COB info on secondary insurance claim

Aha!  now i can reproduce the problem.  I can't print a medical paper claim for the secondary medical policy that includes completed box 9 if the primary is dental.  Incidentally, the primary dental claim includes the secondary medical claim information.  

I'm not sure why this is, but we can find out.

Looping in some other smarties: qadaniellehnnobel‌ what do you think?  Is there an alternate insurance format she can use?

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annag
Canine III

Re: COB info on secondary insurance claim

In MN our medical insurance carriers will only accept e-claims, and they need not only the primary insurance company listed, but they also need the COB information, such as amount paid, Patient Responsibility (Line Adjudication Information). The claim also must be marked as a secondary submission, not primary (Payer Responsibility Sequence Number Code).

Carestream has informed me as recent as April 2016 that at this time, this is not a capability, nor is it planned for the future (Case #5731754). We would love to see this in a future update since we are not compliant with our state guidelines for 2ndary claim submission.

Here's a guide of things our electronic claims are supposed to include:

https://www.bcbst.com/providers/ecomm/bcbst_5010/Electronic_Secondary_Claim_Guideline.pdf 

CS Dental Employee
CS Dental Employee

Re: COB info on secondary insurance claim

Great information.  I'll make sure that our developers see this.

cromfs
Premolar II

Re: COB info on secondary insurance claim

I've never had this happen.  I don't populate the primary info on the claim form-I just submit the EOB with claim via paper since we are out of network with medical and don't pay for MEA.

cjenkins
Canine III

Re: COB info on secondary insurance claim

For now, we are trying to work with our local BCBS rep to find an interim solution, but I'm glad this was brought to your attention and I hope you continue to investigate/work to correct.  Thanks!

cjenkins
Canine III

Re: COB info on secondary insurance claim

In case anyone else is having this issue, I just created a workaround for us.  I scanned the paper 1500 claim form into Adobe Acrobat then programmed it to be a fillable document.  We have to manually type in all the fields instead of it being generated by the system, but at least we get a complete claim without any need to write information on it after it prints.  Luckily it's not something we have to do everyday or else this wouldn't be a workable solution either.

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omsnashville
Premolar II

Re: COB info on secondary insurance claim

Matt, as a TN provider, I supplied this exact information to Carestream as well. I first forwarded these guidelines to C.J. on 2/22/16 (case ref#: 5731359), though those guidelines were not my primary concern on that phone call, so it may have been marked as "resolved" prematurely. The last correspondence I had was on 10/10/16- I spoke with Rosler Mason, who advised that there had been enough requests with regard to this that it has been forwarded on to development (Case ref#: 5996143). I was advised at that time that it might be incorporated as soon as the first update of 2017, but that there was no concrete timetable.

Our local BCBS (our largest contract) advised that our continued refusal (or inability) to send secondary electronic claims according to their specifications (as linked above by annag could jeopardize our contracted status, so this is definitely of high importance to us.

Thank you so much!