Your dental practice management software is programmed to generate a secondary claim once the primary insurance payment has been posted. Standard practice is to submit the secondary claim with all necessary attachments immediately following the automatic generation of the claim. The preferred method for submitting secondary claims electronically with the primary insurance explanation of benefits (EOB) attached. However, some payers are particular about the size of the attachment and will reject the EOB if it is not the original size showing all pertinent information about the primary payer.
If the primary payment was paid on a bulk EOB, meaning multiple patient information listed for single check payment, all unrelated patients and their protected health information (PHI) must be blacked out before submission. When this occurs, it is easiest to send the secondary claim via paper mailed or faxed with the primary insurance EOB attached, and all other information not pertaining to the patient on the EOB blacked out. However, it is always best to process claims electronically for tracking purposes.
When submitting secondary claims, enter “Primary Insurance EOB attached” in Box 35 of the 2019 ADA dental claim form. In addition, check “yes” in Box 39 of the 2019 ADA dental claim form to alert the payer there is an attachment. Entering the required information accurately in Boxes 35 and 39 is a cleaner claim and will reduce the chances of a lost attachment when received by the insurance payer. Claims are read by computer software, even paper claims are scanned and read by software. The information entered in is noted during the scan and the attachment is less likely to be overlooked.
It is important to also note that if you are in-network with one or more of the insurance payers, then you should always submit secondary claims. The first reason being, most PPO contracts mandate that all services be submitted. Refer to your PPO processing policy manual for clarification. The second reason is coordination of benefits. Submitting secondary allows the provider to collect up to the full fee submitted, in some instances thus reducing or eliminating the required write-off.