Mastering Coordination of Benefits

August 2023
Tiffany Wesley, FAADOM

Coordination of benefits (COB) is a consistently challenging area for most dental administrators, regardless of experience. Multiple factors affect the order in which dental claims should be filed to multiple payors. These confusing COB rules often make calculating the correct patient responsibility amount – and any required write-offs – more difficult. Keep reading for an explanation of coordination of benefits, how it works, who regulates it, and the support tools you didn’t know were available to you to master it.


What is coordination of benefits?

As explained in the Dental Administration With Confidence 2023 Edition, “Coordination of benefits (COB) is designed to ensure that insurance claims are not overpaid when a patient is covered by more than one plan.”

The intent behind COB is not to confuse the dental billing process but to make sure the insured is appropriately covered without being over-compensated. Federal and state laws around COB establish the order in which payors reimburse dental claims for patients with more than one plan. In an additional effort to lessen the confusion, the National Association of Insurance Commissioners (NAIC) created a COB model for insurance laws and regulations and reviews them as the COB challenges evolve. 

With this being said, you will be surprised to learn that only about half of fully insured dental plans are regulated by state insurance and COB laws.

How does coordination of benefits work?

When a patient has more than one dental plan, one is designated primary and the dental claim should be submitted to the primary first. The primary should reimburse per its normal plan parameters. If the primary payor does not pay the dental claim in full, the claim is then submitted to the secondary payor for consideration to reimburse the remaining balance. 

In some cases, there may also be a third and fourth benefit plan.

Coordination of benefits fictional scenario

You have a patient, Johnny Smiles, that comes in for a new patient exam and has two insurances – his mother and father both have fully insured dental plans and your doctor is in-network with both insurance payors. The insurance plan information presented is as follows:


Dad’s insurance plan: Delta Dental

Dad’s DOB: 12/13/1979


Mom’s insurance plan: United Concordia

Mom’s DOB: 7/2/1983


Based on this information, which plan is primary?

Mastering coordination of benefits

There is much more to accurate coordination of benefits. We are here to help with the ultimate tool for your dental administration toolbox. Dental Administration with Confidence dives deeper into this subject, along with many others. This guide is filled with proven solutions for both common and complex problems facing every practice today. Dental Administration With Confidence is easy to understand and packed full of information, tools, and solutions to help your team maximize reimbursement, reduce claim denials and delays, increase patient satisfaction, and boost revenue. Plus, it is perfect for both new and experienced team members. 

Grab yours today! You can also save 11% when you bundle it with Dental Coding with Confidence.

And did we mention that we have one-on-one coordination of benefits training? CLICK HERE!



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