WHO/WHAT IS?
What/Who is a Power of Attorney?
A Power of Attorney is appointed by the member to act as an agent on their behalf.
WHAT IS Effective Date of Coverage?
This is the date of eligibility... the date the members plan or benefits become effective/eligibility for use.
What is CB?
CompBenefits
How many "0" zeros are there at the beginning of a members ID?
There are Five (5) zero's "0"
WHAT IS ADA or CPT used for?
PROCEDURE CODE...codes used to determine or give a description of service rendered/to be rendered by a provider (doctor, dentist, nurse healthcare professionals).
NB//:
ADA code= Dental Procedures
CPT code=Medical Procedures
What is COINSURANCE?
This is the PERCENTAGE of medical bill insurance covers after members have met their deductible.
WHAT IS DHMO/HMO?
Health Maintenance Organization
OR
Dental Health Maintenance Organization
INN AND OON
In Network & Out Of Network
If a member is unable to provide a 3rd piece of identifier, what do we request as last resort?
The members Social Security Number (SSN)
WHERE DO YOU FIND THE LITTLE RED MAN/ RED X in CBIS and how do you get rid of it?
The red X represents an error was made, it's found at the base/bottom of the CBIS screen and can be removed by clicking the ctrl button on your keyboard.
What is a DEDUCTIBLE?
This the amount you pay before you are covered by your insurance.
WHAT IS:
This is a routine cleaning, or a professional prophylaxis consists of a thorough scaling and polishing of the teeth.
MBR/MBR's
Member/ Member's
WHAT ARE THE 2 MAIN SYSTEMS WE USE TO AUTHENTICATE A MEMBER?
CompBenefits Information System (CBIS) &
Customer Relationship Management (CRM)
TRUE OR FALSE? We only handle the billing portion of a VISION policy
TRUE
Who is a covered dependent?
A person who is eligible to receive benefits under someone else's insurance.
Who is a Participating Dentist/Provider?
Auth and PREAUTH
Authorization and Preauthorization
If needed and a member is newly enrolled and without an ID card, what is the 3rd piece of identifier that can be used to authenticate the member?
Plan Deductible amt
Plan Maximum amt
Plan copay amt (if any)
Medicare id number if enrolled in that policy.
Product type
WHICH SYSTEM IS USED FOR TEST AND WHICH IS USED FOR PRODUCTION?
TRUE OR FALSE?
The member's Name is a requirement to authenticate the members policy.
FALSE
WHAT IS Capitation?
This is when a dentist provides covered services and in return receives a specific dollar amount on a periodic basis (monthly).
Deductible
DOB
ZIP Code
Members ID number
Your plan has 20% coinsurance, the insurance company covers 80% INN, your medical service INN cost $100 you pay $20 how much does your insurance pay?
Insurance will pay $80, since you have met your deductible.