steve132221

Claim Incorrectly Shows Secondary Coverage

Discussion created by steve132221 on Aug 22, 2017
Latest reply on Nov 17, 2017 by paula1

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

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