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 document describes the specific level of benefits that a group members has under a plan.
What is the Summary of Benefits?
False Expense Reimbursement or Billing, Skimming, Larceny, Check Tampering, Stealing
What are red flags of Asset Misappropriation fraud?
Obligation to follow policies, procedures, and legal requirements of the Company.
What is the Duty of Compliance?
This law sets national privacy and security standards for Protected Health Information.
What is the Health Insurance Portability & Accountability Act or HIPAA?
This Group consists of 9 Members with 3 Dental Providers.
What is the Board of Directors?
This law regulates the transaction of insurance business in New Mexico.
What is the New Mexico Insurance Code?
False Billing, Upcoding, Phantom Billing, Duplicate Billing
What are red flags of Claim Fraud?
Our obligation to always act in good faith in the best interest of DDNM, similar to an ordinarily prudent person in similar circumstance and position.
What is the Duty of Care?
Any non-public, confidential, proprietary, or legally protected information about DDNM or the customers, members, providers, and employees of DDNM.
What is "Protected Information"?
This group of policies provides guidance in ethical decision-making & action in the best interests of DDNM
What is the Code of Conduct?
This bundle of contracts helps us assure access to affordable and quality dental care for our members.
What is the Provider Network?
False Expenses or Reports, Timing Differences, Metric Manipulation
What are red flags of Financial Reporting fraud?
Obligation to disclose any personal or financial interest that may interfere with your ability to carry out your work in the best interests of DDNM.
What is the Duty of Conflict Disclosure?
A tool to secure email containing Protected Information
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 document describes our obligations in providing coverage and services to individual or group members.
What is the Evidence of Coverage or Dental Benefit Handbook?
Inappropriate Gift, Contract to Close Personal Relation, Seize Opportunity for Personal Gain
What are red flags of Corruption fraud?
Our obligation to always act in the best interests of DDNM and subordinate our own personal interests or biases.
What is the Duty of Loyalty?
Combining Personal Identifiable Information plus Personal Identifiable Health Information equals this
What is Protected Health Information?
Dr. Katz, Dr. Purtell, & Dr. Sims
Who are the three New Mexico dentists that help found Delta Dental of New Mexico in 1971?
Often an exhibit, these are service standards that we must meet in rendering services to a group.
What are Performance Guarantees?
Exploiting policies, procedures, & systems to obtain the most money or benefit from an insurer crossing ethical fiscal, business, or dental lines.
What are red flags of "Abuse"?
Obligation to notify the Company of any reasonable suspicion of non-compliance, fraud-waste-abuse, or privacy-security incident
What is the Duty to Report?
A cybersecurity attack where a perpetrator tries to intentionally trick you into disclosing Protected Information either through an email or on a web site.
What is "Phishing"?