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steve132221
Canine III

Claim Incorrectly Shows Secondary Coverage

Has anyone else noticed an issue where a patient only has one active medical (or dental) insurance plan, but their workspace also has a previous (currently inactive) insurance plan, and a claim shows BOTH as active? An example of this could be that a patient was previously seen for an extraction, and let's say this patient had Delta Dental. A couple of years go by, and the patient presents again for another extraction. The patient says they no longer have Delta Dental, but now they have MetLife Dental. So, we would uncheck Delta as active, and add MetLife. Upon removal of the tooth, and creation of a claim, that claim will continue to show two active dental policies, even though Delta is NOT marked as active. If the claim is electronically submitted (indicating two insurers), we always get denials back from the currently active insurer stating that "another insurance plan may be involved etc....". It always stems from the claim form stating there is another insurance, but there really is not.

It seems like deactivating an insurance plan in the patient workspace should immediately be reflected on a claim form, but I can't seem to get that to happen. Any thoughts?

Steve

3 Replies
omsnashville
Premolar II

Re: Claim Incorrectly Shows Secondary Coverage

For us, the main trick is to make sure the termed plan is de-activated in the patient's chart before the new charges are added to the ledger.

If we miss doing this in advance, we have to delete the new charges, de-activate the old plan, then add the charges back in. This will also automatically generate an entirely new claim for your new insurance company. This seems to eliminate those errors for us. I hope this is helpful!

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jpisariktnosi
Premolar I

Re: Claim Incorrectly Shows Secondary Coverage

I agree with Kristina. Also, I've found some things that actually attach themselves to the treatment proposal, so sometimes you may have to input the treatment plan again so that the new info is attached.

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CS Dental Employee
CS Dental Employee

Re: Claim Incorrectly Shows Secondary Coverage

I agree with both you ladies. Honestly that is the best practice because the WinOMS does hold onto the old claim history.  Thank you for your feedback.

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