The insurance plan listed second in the Family module (order = 2) is considered secondary insurance.
If a patient has both primary and secondary insurance and you want benefit estimates to be more accurate, you must set both up as a PPO Percentage plan type. See In-network / Contracted Insurance Plan (PPOs), Option 1.
Usually when you create a claim for a patient with dual coverage, both claims are automatically created at the same time.
- In the Account module, click New Claim and verify claim information. When you click OK, two claims will be automatically created:
- Usually the primary claim will have a status of 'Waiting to Send'.
- The secondary claim will have a status of 'Hold until Pri received'. This claim will stay in the patient's account with the Hold status until sent (step 4).
- Send the primary claim. The claims will look like this in the Patient Account.
- When the primary insurance payment is received, Receive the Claim, then Finalize the Payment. After you enter the payment (click OK on the Insurance Payment (EOB) window), a window will open indicating that a secondary insurance claim exists.
Make note of the claims (copy or print the list), then click OK to close this window.
- Open the secondary claim, verify the claim estimates, then send the secondary claim.
- If sending electronically in 4010 format, the claim information sent to the clearinghouses will not include primary claim payment information.
- If sending electronically in 5010 format, the claim information sent to the clearinghouse will include primary claim payment information.
You may need to send the primary claim payment information to the clearinghouse (e.g. use NEA Fast Attach or send via mail).
Attachment requirements depend on your clearinghouse. Also see E-claim Attachments.
- Some clearinghouses require that attachments (e.g. the primary EOB) are uploaded to first and that the NEA # is sent with the secondary claim.
- Some clearinghouses only require that claim attachments are marked electronic (Edit Claim Attachments Tab) when sent. They will then notify you when the attachment is needed.
Note: If primary insurance is received and not paid as estimated, secondary insurance estimates do not automatically update.
To manually create a secondary claim, select the procedures, then click the New Claim dropdown, Secondary. For example, this might be the process if you set up the secondary plan after creating the primary claim.
Set Coordination of Benefits rules in Family Module Preferences.
Writeoffs for PPOs are typically done on the primary claim only.
Frequently Asked Questions
Q: My primary plan has a plan type of Category Percentage, but my secondary plan is PPO. I want Open Dental to calculate the writeoff. It currently shows as zero. How do I do this?
A. Use the Family Module Preference 'Calculate secondary insurance PPO writeoffs (not recommended, see manual)'. This should only be checked if you understand Coordination of Benefit (COB) rules and use PPO Percentage Plan types for all in network insurance plans.