My Definition
Amount payable or paid, in one sum or periodically, for an insurance policy.
Premium
What is the group name for member 4445072-01
Unum
member 4240605-01 has a dental mod or legacy prior to dental mod
Legacy prior to dental mod
Used for chewing and crushing food
Molars
P001 and P002
High or Low Plan
This is the process used by insurance companies to determine how multiple insurance plans share payment responsibilities when a person is covered by more than one plan
Coordination of Benefits (COB)
4762930-02 needs a benefit breakdown sent to them. what group # would you place in portal
CLAW01
These policies do not Coordinate benefits.
Individual policies- Colonial individual worksite and legacy indiv.
First tooth erupts around what age
6months
MTC never expires for these policies
Individual or Colonial Life Policies.
Where benefits are not payable to replace a tooth that was extracted prior to having coverage
In order to locate the benefit breakdown for 2832259-03 what should be placed in Portal Admin
STATE
member 4762162-01, provider wants to know is there is a MTC. What would be the answer
Yes there is a MTC
The tooth has how many surfaces
5 Surfaces
This procedure needs Narrative, XRay and Charting once all 4 quads are done
SRP
Third Party Partner contracted with Unum Dental & Vision to recommend for claim review, benefits determination and/or alternate course of treatment.
P&R
I need to locate a code for this member 5933710-01 what category could I read from in claims processing guide
DentalMod 20GDN
Member 2523049-01 will be doing a 6782, what is the freq for that code
1 per tooth per 7years
Inflammation of gingival tissue
Gingivitis
One a provider has multiple addresses assigned to multiple fee schedule. I use this to advise of the correct fee schedule.
Fee sch Hierarchy
On the claim form this permits the insured to authorize the insurance company to pay any available benefits directly to the person or institution on whose charges a claim is based.
Assignment to pay benefits
What is the plan description for the Legacy(9heop) account 1493599-01
AlwaysCare OnePlus Individual Standard Fee Schedule Plan
What is the freq for code 0120 for member 4762162-01
2 per 12 months
This is the connecting hinge between the mandible and base of skull
TMJ
Follow ups are assigned to this person once provider is located in TX
Cherese Shine