Dental Basics
What intent should be used when handling UnitedHealthcare Dental claim calls?
Review Dental Claim History
True or False: GPS should only be used when a supervisor is unavailable.
False.
What type of transfer should be used when dental involvement is required?
Warm transfer.
This resource is checked during access validation and contains Specialty Team knowledge
KBV (Knowledge Base View)
What does CSM stand for?
Centralized Service Model
Name one information that is important when searching for a dental claim?
Date of Service
Service Rendered
Name of Provider
Which tab should you select to access Person Search?
Enrollment Tab
Before transferring a call, what should you do first?
Research the issue using available tools.
This job aid helps determine whether services require authorization
Prior Auth List KM1004312
What is does FCR stands for?
First Call Resolution
Which is more useful for locating a specific procedure, the claim summary or service line detail?
Service Line Detail
Name one search criterion that can be used in Person Search.
Member ID, Medicare ID, First Name, Last Name, or DOB
A member becomes frustrated after being transferred twice. What skill should be immediately demonstrated?
Empathy
This tool helps advocates investigate claim details and member responsibility
Claim Research Tool
The three call handling expectations of a CSM advocate.
Handle the Issue from Start to Finish
Use Your Resources
Advocate for the Member
What two unique details are found on dental claims that are not commonly found on medical claims?
Tooth Identifier and Tooth Surface Code
A member calls and says:
"I moved recently, never received my ID card, and want to know if anything was mailed to me."
Name the three GPS areas you should review.
True or False: Every dental claim call requires a transfer.
False
What communication framework uses Know, Show, Empathize, Confirm Understanding, and Confirm Next Steps
Know-Show-Confirm (KSEC-C)
Besides reducing transfers, what two operational outcomes does CSM aim to improve?
Name 3 responsibilities of an advocate when handling dental claim inquiries.
Every time you access GPS, what is created on the member's account?
Footprint Notes
What is the best way to avoid unnecessary transfers?
Take ownership and resolve the issue when possible.
Name resources a CSM should routinely leverage before considering a transfer.
Which training topic teaches advocates to recognize barriers affecting member health?
Social Determinants of Health (SDoH)