Dentacom
What system do we use to check a member's eligibility?
CED would also accept i2/i4
Is there any timely filing for DPPO claims?
For INN- there is no timely filing. For OON- they have one year from the DOS.
How would we send a PCS using Webster?
F4 option 11
True or False- the entire family has to be assigned to the same office?
False, each member can be assigned to a different office if need be.
What is the turn around time if you mail something to a member?
15 business days
What system do we use to look at a members preventive history on file?
I6
If we are looking at a claim in I6, which key would we hit to look at the payment information?
F8
What is the SNID?
The super network ID
What is a fee tier?
A specialists contracted rate
When we open a referral on our end how long until it expires.
90 days
What keys do we use to go from Dentacom to CED?
Shift F12
If the claim form states- payment-Y, who would Cigna issue the payment to?
The dental office
What keys do we use to look at Encounters?
Shift F5 option 37
What are the four ways that an NGD can be paid?
1. members copay
2. capitation
3. supplemental
4. additional compensation
What type of claims can SDA process over the phone?
BA claims, no reviewer claims.
What screen do we use to look at a member's benefits? (COINS,DED,MAX)
IH
If Cigna is secondary, what information would we need from the primary insurance in order to process?
We would need the EOB showing what was covered for that DOS.
How can we look at providers by zip code in Webster?
Double click the assigned dental office number or hitting f5 on the office # on the member summary screen.
When would a standard transfer take effect?
The 1st of the following month
What is the timely filing for an encounter?
90 days from the DOS
When using p8, if the FREQ section shows 999 1 1, what is the frequency of that code?
Once per lifetime
If there is claim for Scaling and root planing that is pending for more information, what information might we be looking for?
Perio charting
Where would we look to see if the member has an office visit copay in Webster?
F4 option 4, on the right hand side.
If the Dental Office is XX Capped, give me the steps we have to take to complete a transfer.
Get member approval, call the office and confirm they would accept the transfer and then reach out to PSU to lift the lock to complete the transfer.
From the member summary screen what are all the steps i would take to see if the Dental office has additional compensation?
F10 to go to the DOM and then F2 page 3. Look on the bottom right side to confirm.