How to Submit Coordination of Benefits (COB) Claims in Dental Billing
Submitting coordination of benefits (COB) claims is an essential skill in dental billing. When patients have dual insurance coverage—such as a primary and secondary policy—submitting claims correctly can ensure full reimbursement and prevent delays, denials, or overpayments. COB can feel confusing, especially if you’re new to the process, but with a clear understanding of the rules and proper documentation, your practice can collect what it’s owed efficiently and compliantly.
This article provides a step-by-step breakdown of how to submit COB claims in dental billing. If you’re ready to elevate your career and master dental billing and coding, the American Dental Coders Association (ADCA) offers professional certifications like the Certified Dental Billing Specialist (CDBS) and the Certified Dental Coder (CDC). You can also learn more about the Dual Certification Program to earn both credentials.
What Is Coordination of Benefits (COB)?
Coordination of benefits occurs when a patient is covered under more than one dental or medical plan. The COB process determines the order in which claims should be submitted and how benefits are distributed between plans to avoid overpayment.
Why COB Matters
- Ensures accurate reimbursement
- Prevents duplicate payments by insurance carriers
- Reduces the chance of insurance fraud
- Speeds up claim processing when done correctly
Identify If the Patient Has Dual Coverage
Start with verifying if the patient is covered under more than one insurance policy. This information is usually obtained during the new patient intake or when updating insurance records.
Key Information to Collect:
- Name of both insurance companies
- Subscriber names, relationships, and birthdates
- Policy numbers and group IDs
- Which plan is primary and which is secondary
- Any coordination of benefits rules specific to the plans
Determine the Primary and Secondary Insurance
Correctly identifying which plan is primary is crucial before submitting COB claims.
General Rules for Determining Primary Insurance:
- Employee vs. Dependent: The insurance held by the patient as an employee is usually primary.
- Birthday Rule: For dependents, the parent whose birthday comes first in the calendar year typically has the primary plan.
- Court Orders: In cases of divorce, a court order may define which parent’s plan is primary.
- COB Clauses: Review each plan’s COB clause to determine hierarchy.
Step-by-Step Guide to Submit COB Dental Claims
Step 1: Submit to the Primary Insurance First
- Use the ADA claim form or your practice management software
- Include all required procedure codes, fees, and supporting documentation
- Wait until the claim is fully processed and an Explanation of Benefits (EOB) is received
Step 2: Review the Primary EOB Carefully
- Note what was paid, what was disallowed, and what is still owed
- Check for any deductible or coinsurance amounts
- Ensure the payment is correctly applied to the patient ledger
Step 3: Prepare the Secondary Claim Submission
Now that the primary has paid, you can submit to the secondary insurance plan.
Include the Following:
- Completed ADA claim form (or CMS-1500 for medical payers)
- A copy of the EOB from the primary insurance
- Any necessary attachments, such as x-rays or narratives
- Total billed fees, not just remaining balances
- Indication that the primary has paid (e.g., marking Box 11d on ADA form)
Step 4: Follow Up Promptly
- Monitor claim status through payer portals or clearinghouses
- Respond to requests for additional documentation quickly
- Ensure all adjustments are posted to the patient’s ledger after both payments
Tips for COB Billing Success
- Verify both insurances at every visit—coverage changes frequently
- Always bill full fees to both insurances (not the balance after primary payment)
- Educate patients that secondary doesn’t guarantee 100% coverage of the balance
- Document everything in the patient’s record, including call notes and policy rules
- Use accurate CDT codes and modifiers as needed
COB Scenarios and Examples
Scenario 1: Two Active Dental Plans (Spousal Coverage)
- Jane is covered under her employer and her spouse’s employer
- Her employer plan is primary, and spouse’s is secondary
- Submit first to her plan, then submit EOB and full charges to spouse’s plan
Scenario 2: Child Covered Under Both Parents
- Child is covered by both parents’ insurance plans
- Apply the birthday rule unless a court order dictates otherwise
- Submit to parent with the earlier birthdate in the calendar year
Scenario 3: Dental and Medical Coverage
- COB may apply when a service is eligible for both dental and medical billing (e.g., trauma)
- Submit to the appropriate plan based on payer policy and medical necessity
Training for COB and Dual Insurance Claims
Handling dual coverage claims requires deep knowledge of insurance rules, documentation requirements, and payer protocols. Without proper training, practices risk underbilling, noncompliance, or lost revenue.
The American Dental Coders Association (ADCA) offers online certification programs designed to make you COB-ready:
- Certified Dental Billing Specialist (CDBS) – Learn billing systems, claims management, and COB best practices
- Certified Dental Coder (CDC) – Master coding procedures, documentation, and cross-claims accuracy
- Dual Certification Program – Become both a certified dental biller and coder for maximum career advantage
If you already have experience and simply need to validate your skills, skip directly to certification:
Conclusion
Submitting coordination of benefits claims may seem intimidating, but with the right workflow and training, it becomes second nature. Understanding how to verify, document, and submit claims to both primary and secondary insurers ensures your practice gets paid properly and patients get the most from their coverage.
Whether you’re new to COB or want to fine-tune your skills, certification from the American Dental Coders Association will give you the confidence and credentials you need. Enroll in the Certified Dental Billing Specialist (CDBS), the Certified Dental Coder (CDC), or the Dual Certification Program to take your career to the next level.
Experienced but uncertified? Prove your expertise with our Certified Dental Billing Specialist Exam or Certified Dental Coder Exam.
