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when 2 insurances are involed do you adjust the primary or the higher of the 2?

January 8, 2025 by Admin

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  • when 2 insurances are involed do you adjust the primary or the higher of the 2?

when 2 insurances are involed do you adjust the primary or the higher of the 2?

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i was told you should always take only the primary adjustment but was always taught to take the higher amount. which is it?

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Posted by Admin
Asked on January 8, 2025 8:20 am
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What is the secondary changed their fees/policy? If 100 allowed, primary paid 80, then I would transfer the $20 to the secondary, let the secondary adjudicate then make my adjustments. I am not saying balance bill. The primary allowed 100, I would transfer up to that just like EOB says to secondary. You could be leaving money on the table as often as insurance changes what they are going to do. IMO Angela Miller

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Posted by medaudsolutions
Answered on April 8, 2025 3:17 pm
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    Hello! This would be determined by the coordination of benefits. Typically, if the primary ins pays more than the contracted fee of the secondary ins (ex: Cigna is primary, Delta Dental is secondary. Total fee for D0120 is $60. Cigna pays $40 for D0120 and Delta's contracted fee for a D0120 is $25) you would post the Delta payment, transfer the remaining balance for the D0120 ($20) to Delta and write off the $20 under an adjustment on the Delta plan and specify that the primary ins paid more.

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    Posted by AR
    Answered on April 7, 2025 4:02 pm
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      Hello! This would be determined by the coordination of benefits. Typically, if the primary ins pays more than the contracted fee of the secondary ins (ex: Cigna is primary, Delta Dental is secondary. Total fee for D0120 is $60. Cigna pays $40 for D0120 and Delta's contracted fee for a D0120 is $25) you would post the Delta payment, transfer the remaining balance for the D0120 ($20) to Delta and write off the $20 under an adjustment on the Delta plan and specify that the primary ins paid more.

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      Posted by AR
      Answered on April 7, 2025 4:01 pm
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