PPO/HMO
The BCB for all name brand or premium restorations for PPOs.
What is the porcelain option or lab fabricated option?
This is required in the subject line of your email, when sending any PHI via email to an outside organization or outside of pacden.com.
What is [secure]?
Your office's __________ is calculated by
Total Collections $ divided by Total Production $.
What is your office's collections %?
Johnny has a 2/12m frequency for exams and has a PPO that runs on a calendar year. He had a CCX exam on 2/1/2024, ER exam on 5/4/2025. His insurance has coverage for an exam on what date?
What is 2/2/2025?
You click on this icon on your hyperspace toolbar to document any clinical conversations with a patient.
What is the telephone call icon?
The $59 for the NP special, gets applied to this procedure?
What is the Hygiene procedure?
(prophy, PMV, Gingival Scale, 1 quad of SRPs)
According to your Collection Drivers, the Initial Pre-Reg % needs to be above this benchmark?
What is 90%
This term references, when a PPO carrier pays on a downgraded material and not the actual procedure being preformed?
Example: Insurance pays and downgrades to an FMC for a Posterior Porcelain crown.
What is a Alternative Paid Benefit?
In this WQ you will find ALL pending treatment that hasn't been completed or scheduled and needs to be followed up on?
What is the treatment plan follow up WQ?
Patient's scheduled for specialty can sign consents up to this many days in advance.
What is 7 days?
On your office P&L, this line item represents how profitable your office is?
What is NOI, Net Operating Income?
For HMOs, this is the industry standard on determining the cost of optional/alternative restorations to patient's when they choose to go outside their BCB.
What is OTF, or Optional Treatment Formula?
This icon/activity allows you to view all of the patient's available invoices/EOBs.
What is the invoice docs?
After having a conversation with a patient in regards to a balance, this is where you would document the conversation and view it for future reference.
What is Guarantor notes and the View History tab in the guarantor account?
On your office P&L, every operating expense line item (lab & supply, SG&A, labor, etc) is a paid out of this line item of revenue?
What is collections?
This reference tool tells you how and if an insurance carrier will pay if a provider is not credentialed, as well as proper verbiage on how to speak to patients when a provider is not credentialed.
What is the Out of Network Maximizer?
When accounts are in this WQ, production has been recognized but the insurance payor has not accepted the claim yet and it will delay insurance payments.
What is Claim Edit WQ?
All denied claims will fall into this WQ for the office to follow up and possibly rebill.
What is the Follow up - Claim Action Needed WQ?
This back office workflow identifies patient's that need to see a specialist and is inputted during the exam. It transfers the trust and protects the liability of the provider on the diagnosed treatment. It also allows the front office to easily identify and follow up with those patient within a WQ.
What is create a clinical specialty referral?