Corp Governance
To promote the oral health & wellness of the people and communities of New Mexico by encouraging the distribution of dental care and services.
What is the Mission of Delta Dental of New Mexico?
This Policy Form describes the networks & specific level of benefits that group members have under a plan.
What is the Summary of Benefits?
False Expense Reimbursement or Billing, Skimming, Larceny, Check Tampering, Stealing . . .
What are Asset Misappropriation Red Flags?
Obligation to follow Policies, Procedures, & Legal Requirements, including the Code of Conduct & Values.
What is the Duty of Compliance?
This law sets national privacy and security standards for Protected Health Information.
What is the HIPAA or Health Insurance Portability & Accountability Act?
This Group consists of 9 Members with 3 Dental Providers.
What is the Board of Directors?
This State Law authorizes the Superintendent to regulate the insurance industry in New Mexico.
What is the New Mexico Insurance Code?
False Billing, Upcoding, Phantom Billing, Duplicate Billing, . . .
What are Claim red flags?
Obligation to act in good faith in the best interests of DDNM like an ordinary prudent person in a similar position and circumstance.
What is the Duty of Care?
Any non-public, confidential, proprietary, or legally protected information about DDNM or its customers, members, providers, or employees.
What is "Protected Information"?
This Group of Policies guides us in ethical decisions & actions in the best interests of DDNM.
What is the Code of Conduct?
This Bundle of Contracts with dentists helps us assure member access to affordable and quality dental care.
What is the Provider Network?
False Expenses, False Reports, Metric Manipulation, Understating-Overstating . . .
What are Financial Reporting red flags?
Obligation to disclose any Personal or Financial interest that may interfere my ability to do my job objectively and in the best interests of DDNM!
What is the Duty of Conflict Disclosure?
A tool to secure the electronic transmission of Protected Information, most often used with email.
What is "Encryption"?
This Group meets every Thursday afternoon to discuss the performance and operations of the company.
What is the Senior Management Team?
This Policy Form provides individual or group members with information on how to access their dental benefits, as well as the services that we provide.
What is the Evidence of Coverage or Dental Benefit Handbook?
Accepting an Inappropriate Gift or Bribe, Personal Work on Company Time, Taking an Opportunity from the Company, Steering Work to a Close Personal Relation. . .
What are Corruption red flags?
Obligation to always put the best interests of DDNM first, over any personal interest or bias.
What is the Duty of Loyalty?
A type of information that combines both Personal Identifiable Information AND Personal Health Information.
What is Protected Health Information?
Dr. Katz, Dr. Purtell, & Dr. Sims
Who are the three NM dentists that help set-up our company in 1971?
This Exhibit of a group contract sets the service standards for us in delivering service under a "Insured" or "ASO" plan.
What are Performance Guarantees?
Exploiting Policies, Procedures, & Systems to obtain the most money or benefit from an insurer, often crossing ethical fiscal, business, or dental lines. . .
What are Abuse red flags?
Obligation to notify my supervisor, the Compliance Officer, or Ethics Line for any good faith, reasonable suspicion of non-compliance, violation of law, fraud-waste-abuse, or a privacy-security incident.
What is the Duty to Report?
A cybersecurity attack where a bad guy tries to trick you into disclosing Protected Information through an email or link to a fake website.
What is "Phishing"?