Dental Under Medical
Terminology- Periodontics is defined as:
What is the branch of dentistry that deals with the study of treatment of periodontal Gum disease.
How long does it take to process a new claim for an in Network provider?
What is:
10-15 Business Days
What types of calls does Cigna Receive on a daily basis?
Looking for at least (3)
What is:
Benefit Coverage
Clarify Eligibility
EOB questions
Clarify documentation was received by an office or by Cigna.
Name the 3 standard benefit limitations customers are typically responsible for:
Deductibles
Coinsurance's
Copays
What is an EOB and whom receives it?
What is:
EOBs are explanations sent to patients to explain how claims were processed and what they woe to their Health care professional. Eobs are sent to the patient unless the patient does not have a liability or an amount to pay the health care professional.
Terminology- Oral Surgery:
What is :
The Branch of dentistry concerned with the surgical and adjunctive treatment of diseases, injuries and deformities' of the oral and maxillofacial Region,
How long does it take for a customer to receive an Id card in the mail?
What is:
7-10 Business Days
Before fullfilling a customers request to speak with a Manager or Supervisor we should always try to:
What is:
Deescalate the caller.
What is Conduent?:
What is:
a third party paper mailroom vendor for Cigna.
What is:
EOPs are similar to the eob by providing the claim reimbursement information, however EOPs are sent to the health Care provider.
The following Dental Services maybe covered under medical.
What is:
Orthognathic Surgery
Anesthesia Services related to dental procedures
Dental Accidents
Inflammation and infection of teh gums, cheek and tounge.
Treatment of Temporomandibular Joint disorders or TMJ.
How long does it take to process a claim adjustment request?
What is:
5-10 Business Days
Can we transfer a provider call to the ECT Line?
What is:
No, ECT line only takes customer calls
What is conduents role? Or Responsibilities (name at least 3)
Receiving, Storing, and preparing paper claims submissions (mail and faxes)
Assigning Cigna Receipt Date
Scanning the paper to create an electronic image of the paper
Assigning a DCN to view in Filenet for Facets
Extracting or keying data submitted on the paper claim according to the Cigna Business Requirements
Creating both electronic data and image files for transmission to Cigna.
A claim is presented in Auto Adjudication (AA) for processing. the claim systematically processed when AA criteria are satisfied. If AA criteria are not met, the claim will p0resent to adjusted for manual processing
Tell me what DDAR Means and what it is:
What is:
Direct Deposit Activity Report. this is issued to the health care professional in place of the EOP when the health care professionals is paid via EFT.
DDARs are used by health care professionals to confirm payment received and to post payments to patients accounts
Specific Conditions from these two criteria must be met for Cigna, to cover orthognathic surgery:
What is:
Facial Deformities
Functional Impairments
What is the the standard processing times for requests processed by the Central HIPPA Unit (Such as the authorization for disclosure of Protected Health Information form) ?
What is:
30 Calendar Days
What is:
Monday-Friday 8am-10pm Est, Saturday 930-6 pm est.
Name the Claim Systems we use on our Platform:
What is:
Facets
What is:
Adjustment Teams
Customer Service Departments
National COR and Appeals Team
National Overpayment Recovery
Prepay Processors
Cigna does NOT cover distraction Osteogenesis for these Conditions because they are NOT considered Medically Neccesary:
What is:
In Preparation for dental implants or orthodontic care.
For sole purpose of improving individual appearance and profile.
How long does it take for a check to be reissued?
What is:
15 calendar Days?
What process do you as our GPS Team take for provider Escalated calls
What is:
Transfer to the designated Tier 2 or team Lead for handling.
What is:
Procedure and Diagnosis codes
Does other insurance exit?
Eligibility Active?
Networks and Contracts
What is the ECPP? And what is its functionality?
What is the External Claim Process (ECPP)
in some cases Cigna uses an outside vendor to externally price participating claims for Cigna-owned contracts. These are contracts that are for the Cigna network but due to limitations, cannot price the claim and the third party vendor (TPA) or Client Specific Network (CSN) has contracted rates. For instance Cigna does not have the lability to internally price claims when eh diagnosis related group (DRG) Payment Applies