Wiki Dental Billing NEED ADVICE - AM I CORRECT OR NOT?

hopefwalker

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Hello,
I am a dental biller and need some advice about what is the final patient responsibility. I work for an oral surgeon and the patient had wisdom teeth surgery with anesthesia. The patient has medical & dental insurance. We are in network with the medical and out of network with the dental. Medical only processed and paid for the anesthesia but the wisdom teeth are not covered under the medical plan. And then the claim was sent to dental with the medical eob and was processed as out of network. The patient wants the contracted adjustment from the medical but I feel that is incorrect because we are out of network with dental so there is no coordination. What are your thoughts on this?

Then a medical biller, who has never done dental billing, works with me feels that the dental eob should be reprocessed because line by line of the anesthesia don't match with the medical eob and that means line by line, the dentist was overpaid. I am trying to explain that is not what that means, they are two different entities processing the claim! I hope I explained myself well lol.
 
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