Secondary Insurance

The Insurance Plan listed second in the Family Module (order = 2) is considered secondary insurance.

Note: 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 PPO Insurance Plan, Option 1.

Usually when you create a claim for a patient with dual coverage, both claims are automatically created at the same time.

  1. 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).
  2. Send the primary claim. The claims will look like this in the patient account.
  3. When primary Claim Payment are received, receive the claim, then finalize the payment. After you enter the payment (click OK on the Insurance Payment (EOB) window), you will receive one of two popups.

    If the Account Module Preference for Prompt for secondary claims is checked, you will have three options.

    • Change the claim status to 'Waiting to send': Change the status of the secondary claim to Waiting to Send.
    • Send secondary claim(s) now: Send the secondary claim now.
    • Do Nothing: Do not change the secondary claim.

    If the Account Module Preference for Prompt for secondary claims is unchecked, you will see a list of secondary claims.

    1. Make note of the claims (copy or print the list), then click OK to close this window.
    2. 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.

Attachment requirements depend on your clearinghouse. Also see Electronic Attachments.

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 ( COB ) rules in Family Module Preferences.

Write-offs for PPOs are typically done on the primary claim only.

Questions & Answers

My primary plan has a plan type of Category Percentage, but my secondary plan is PPO. I want Open Dental to calculate the write-off. It currently shows as zero. How do I do this?

Use the Family Module Preference Calculate secondary insurance PPO write-offs (not recommended, see manual). This should only be checked if you understand COB rules and use PPO Percentage Plan types for all in network insurance plans.