A client with two plans can seem like good news, but billing the wrong plan first is a reliable way to get a denial. Coordination of benefits rules decide which plan pays first.
Find the primary plan
A client’s own employer plan is usually primary, and coverage through a spouse or parent is usually secondary. For children covered by both parents, many plans use the birthday rule: the parent whose birthday falls earlier in the calendar year has the primary plan.
Bill in the right order
Send the claim to the primary plan first. Once it pays, send the claim and the primary plan’s explanation of payment to the secondary plan.
Keep the information current
Ask clients at intake, and again every year, whether their coverage has changed, and ask them to update their plans’ coordination of benefits records if needed.
A short question on your intake form saves many hours of rework.