Navigating the complex world of dental billing in New Jersey becomes even more challenging when a procedure qualifies for both medical and dental coverage. Many providers miss out on legitimate reimbursements simply because they don’t know when or how to bill both medical and dental insurers in New Jersey.

Streamlining this dual-claim process helps ensure your practice gets paid efficiently and compliantly. In this blog, we’ll break down when you should consider billing both types of insurers and how to do it right the first time.

When Should You Bill Medical Insurance for a Dental Procedure?

While most dental services are billed strictly to dental insurance, certain procedures can and should be billed to medical payers. Medical billing is appropriate when:

• The dental procedure treats a medical condition (e.g., oral surgery following trauma or cancer).


• The patient has a congenital anomaly, such as a cleft palate.


• The procedure addresses a systemic condition, like obstructive sleep apnea (oral appliance therapy).
• You perform a biopsy, pathology report, or TMD-related treatment.

In short, if the procedure is medically necessary and documented appropriately, you can bill the patient’s medical insurance first, even in a dental setting.

Why It Matters for New Jersey Providers

Dental billing in New Jersey is particularly nuanced because many insurance companies, especially large medical payers like Horizon Blue Cross Blue Shield or AmeriHealth, require very specific coding and documentation. Moreover, failing to coordinate benefits properly can result in denied claims or payment delays.

Understanding this crossover is crucial for maximizing reimbursements and staying compliant with payer guidelines. That’s why smart practices are turning to dedicated dental billing services for New Jersey practices that know how to navigate both systems effectively.

How to Bill Medical and Dental Insurers in New Jersey: A Step by Step Guide

1. Verify Insurance Eligibility Thoroughly

Before treatment begins, verify both the medical and dental benefits. Understand the patient’s policy on dual coverage, coordination of benefits (COB), and whether a referral or pre-authorization is required from the medical insurer.

2. Document Medical Necessity Clearly

Use SOAP-style clinical notes to clearly explain the reason for treatment, medical necessity, and diagnosis codes (ICD-10). Include supporting documentation such as radiographs, exam notes, and referral letters if available.

3. Choose the Correct Codes

Use CPT codes for the medical claim and CDT codes for the dental claim. Ensure that the medical procedure code aligns with the diagnosis and is supported by your documentation.

4. Submit to Medical Insurance First

Medical should be billed first when it’s the primary payer. Once the Explanation of Benefits (EOB) is received from the medical insurer, you can submit the claim and EOB to the dental plan for secondary payment (if applicable).

5. Track Denials and Appeals Efficiently

In New Jersey, medical insurers may require additional documentation or deny claims due to coding discrepancies. Having a team that understands medical and dental insurers in New Jersey can make the appeals process quicker and more successful.

Let Instapay Handle the Complexity

If your office is struggling with cross-claim issues, Instapay Healthcare Services is here to help. Our expert team offers specialized dental billing services for New Jersey practices, including dual-claim billing, prior authorizations, and denial management.

We’ve helped countless practices increase their reimbursement by ensuring they don’t leave money on the table when a procedure qualifies for both types of insurance. With our help, you’ll avoid administrative headaches and improve cash flow—without compromising compliance.

Billing both medical and dental insurers in New Jersey requires precision, coordination, and deep knowledge of payer rules. But with the right partner, it doesn’t have to be a burden. Instapay Healthcare Services can handle the complexity so your team can focus on delivering great care.

Need help with dental billing in New Jersey? Contact us today to get started.