Stay True "Duties"
This document sets behavioral expectations and duties for employees.
What is the Code of Conduct?
This group meets every week to check the financial, operational, and strategic performance of DDNM
What is the SMT?
This is non-public, confidential, proprietary, or legally protected information about our company, customers, members, or employees.
What is Protected Information?
The standards in contracts with large group customers that may cost us money if we fail to meet them.
What are Performance Guarantees?
Falsification or mistatement of invoices, expense reimbursement, reports or metrics to steal the company's money or assets.
What are Financial Red Flags?
Dr. Katz, Dr. Purtell, Dr. Sims, and the NM Dental Association
Who set-up Delta Dental of New Mexico and its objects and purposes in 1971?
Donuts & Statistics?
Who is Kai Udall?
This duty requires us to put Delta Dental of New Mexico's interests ahead of our own interests and disclose conflicts.
What is the Duty of Loyalty?
This state regulator governs the transaction of insurance in New Mexico.
What is the OSI?
This tool helps you electronically transmit Protected Information in a secure way.
What is Encryption?
Under this contract, dentists agree to deliver covered dental services to Members under predetermined fee schedules.
What is the Participating Provider Agreement?
Routinely rendering unnecessary services or exploiting coding, policies, procedures, or systems, all to obtain the most money or benefit from the company that may cross ethical, fiscal, business, or dental lines.
What are Abuse Red Flags?
This internal committee oversees the compliance-erm program and meets quarterly.
What is the Compliance-ERM Committee?
One day while in Montana. . . .
Who is Lou Volk III?
This duty requires us to act in a diligent, well-informed and professional manner, usiing common sense and good business judgment.
What is the Duty of Care?
This law sets national privacy and security standards for Protected Health Information.
What is HIPAA?
You should never share Protected Information through this type of insecure connection.
What is Public Wi-Fi?
These sets of contracts with dental providers helps us deliver trusted access to quality dental benefits for our Members.
What are the Delta Dental Provider Networks?
Billing for a crown never performed, upcoding, duplicate billing, using an x-ray of one patient for another to support a claim . . . .
What are Claim Red Flags?
This discipline identifies, assesses, and responds to risks and opportunities to achieve the Mission & Strategic Plan.
What is Enterprise Risk Management or ERM?
Velocity, Viscosity, Juice & Squeeze
Who is James Dickey?
This duty requires us to comply with the Mission, Code of Conduct, laws, and corporate policies.
What is the Duty of Compliance?
Type of agreement where DDNM provides services to a group customer without assuming risk?
What is ASO?
This cyber threat often attempts to trick employees into revealing credentials or disclosing Protected Information.
What is Phishing?
This contract authorizes certain licensed professionals to sell our products, services, and network access to customers.
What is the Producer Appointment Agreement?
Accepting an inappropriate gift or bribe, personal work on company time, taking a business opportunity from the company, steering work to friends and family. . .
What are Corruption Red Flags?
You should do this when you have a conflict of interest?
What is disclose the conflict and recuse?
"Knicks in Five"
Who is Juan Carreon?
This duty requires us to ask questions and raise concerns about non-compliance, conflict of interest, data-privacy incident, or insurance fraud waste or abuse.
What is the Duty to Report?
This association protects Delta Dental trademarks. We can use the Delta Dental name & logo if we comply with their standards.
What is the DDPA?
We must never input Protected Information nor let this learning tool make decisions or replace your expertise and common-sense good business judgment.
These two policy forms establish the Policy or Plan that outline the benefits and services available to a Member.
What is the Dental Benefits Handbook and Summary of Benefits?
Paying the same claim twice because of poor controls, rework due to repeated data entry errors, redundant or inefficient workflows, overpayments due to poor reconciliation, paying software licenses that are not used. . .
What are Waste Red Flags?
This clear articulation explains why Delta Dental of New Mexico is the best choice for customers and stakeholders in exchange for premiums and fees.
What is the VALUE PROPOSITION?
"I keep my side of the street clean."
Who is Alex Sanchez?