Dental billing is a straightforward process, but it can be overwhelming due to the vast amount of dental plans that are billed. In addition to private plans, there are military, Medicare, and federal plans. Each has its own billing process. Billing federal plans can seem complex. Here are some tips on just how to bill federal dental plans.
Who is covered under federal dental plans?
Both current and retired federal employees and their dependents are eligible for federal dental plans. Federal employees include a wide range of workers, including politicians, postal workers, and those who work in government offices.
How do federal dental insurance benefits differ from private dental insurance benefits?
Federal dental benefits are unique in that they are paid under both the patient’s medical and dental plans. The medical plan has a dental rider, which allows for coverage of specific treatments. The remaining treatment is then covered under the dental plan. This means that federal patients always have dual coverage. So when you see that a patient is a federal employee, always obtain both their medical and dental coverage because you will need to bill them both.
Is the federal medical plan primary or secondary?
The federal medical plan is always primary and will be billed first. Once the EOB is received, the dental plan can be billed. If you are nearing the filing limit, send the dental claim without the EOB as some federal carriers will still process it.
How do I bill a federal medical plan?
Federal medical plans can be billed using the ADA claim form and CDT codes. Although private medical plans require the CMS 1500 claim form and CPT codes, federal medical plans do not. Because these plans have a dental rider, they can process claims just as dental insurance would.
What does the federal medical plan cover?
Although federal medical plans are always billed as primary, there is a limited amount of treatment these plans cover. Most of the treatment covered is diagnostic such as exams and x-rays. Although you will need to bill all treatment to the medical plan to obtain an EOB, don’t expect any payment for most of it.
How do I recognize a federal dental or medical plan?
Multiple carriers offer both federal dental and medical plans. The dental plans will include the acronym FEDVIP and the medical plans may include FEP or FEHP. Some plans have other identifiable features. For instance, the subscriber ID always begins with R in BCBS federal medical plans.
How do I process dependent coverage?
The process is the same unless the dependent patient also has their own coverage. In this case, their coverage is primary, the federal medical plan is secondary, and the federal dental plan is tertiary.
When a patient has a federal dental plan, there are added steps required for billing. If you find yourself struggling with them, consider partnering with eAssist for your billing needs. Our Success Consultants are knowledgeable in all types of dental coverage. We will ensure your claims are billed correctly. To find out more, complete the form below.
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