Most often, ForwardHealth is the payer of last resort for any covered service. This means services should be billed to commercial health insurance prior to being submitted to ForwardHealth for payment.
Providers are required to indicate the appropriate other insurance indicator (OI) on dental claims and to report the outcome of any other commercial insurance submission.
OI indicators to be used:
- OI-P- PAID in part or full by other insurance and indicate amount paid
- OI-D- DENIED by other insurance or payment applied toward coinsurance and/or deductible
- OI-Y- YES, member has other insurance, but it was not billed for reasons such as:
- Member denied coverage or will not cooperate
- Service in question is not covered by the carrier
- Commercial insurance failed to respond to initial and follow-up claims
- Benefits are not, or cannot be assigned
- Benefits exhausted
Effective July 11, 2016, providers are required to use OI-Y on dental claims if patient-member has other insurance, but it was not billed for any of the reasons listed above.