Dentacom
What is the main system we use to check a member's eligibility?
CED
Is there any timely filing for DPPO claims?
For INN- there is no timely filing. For OON- they have one year from the DOS.
How would we send a list of INN providers using Webster?
F4 option 11
True or False- the entire family has to be assigned to the same office?
False, each member can be assigned to a different office if need be.
What is the turn around time if you mail something to a member?
15 business days
What system do we use to look at a members preventive history on file?
I6
If we are looking at a claim in I6, which key would we hit to look at the payment information?
F8
What is the SNID?
The super network ID
What is a fee tier?
A specialists contracted rate
What is a general dentist claim called?
An encounter
What keys do we use to go from Dentacom to CED?
Shift F12
If the claim form states- payment-Y, who would Cigna issue the payment to?
The dental office
What keys do we use to look at Encounters?
Shift F5 option 37
What are the four ways that an office can be paid?
1. members copay
2. capitation
3. supplemental
4. additional compensation
What type of claims can SDA process over the phone?
BA claims, no reviewer claims.
What screen do we use to look at a member's benefits? (COINS,DED,MAX)
IH
If Cigna is secondary, what information would we need from the primary insurance in order to process?
We would need the EOB showing what was covered for that DOS.
How can we look at providers by zip code in Webster?
Double click the assigned dental office number.
When would a standard transfer take effect?
The 1st of the following month
What is the timely filing for an encounter?
90 days from the DOS
When using p8, if the FREQ section shows 999 1 1, what is the frequency of that code?
Once per lifetime
If there is claim for Scaling and root planing that is pending for more information, what information might we be looking for?
Perio charting
Where would we look to see if the member has an office visit copay?
F4 option 4, on the right hand side.
Where would you go to pull the supplemental fee schedule?
Go to the customer service site, click dental office materials and then choose the correct option based on the dental offices state.
What is the DORG?
Dental office reference guide- a guide to what a contracted provider can and can not do as part of their contract.