Dentacom
What system can we verify if a member has Cobra coverage?
CED
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 list of INN providers using Webster?
F4 option 11
What is the pediatric age limit and do they have to be assigned?
Up to the age of 13 and no they do not need to be assigned.
How do we receive outside emails from a member?
Through the Cigna Secure link using their MyCigna log on
What screen can we use to send a member an EOB through the mail?
L1
If we are looking at a claim in I6, where do we look to see if a claim was paid by EFT or check?
F8
Are their timely filling for Encounters and Referrals?
Encounters 90 days from DOS, Referrals none
Can a member go to an OON provider and when?
Specialist only, and if there are no INN within a 25 mile radius
Do DPPO plans need referrals for specialists?
No
What keys do we use to go from Dentacom to CED?
Shift F12
What other systems can you use to find claim information besides Oneveiw?
Dentaque, Sir, NEA Look up tool, Dentacom I6 screen
When would a standard transfer take effect?
The 1st of the following month
What specialists need referrals on a DHMO plan and who does it come from?
Any specialist other than an orthodontist or pediatric dentist. Ref comes from GD
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.
In what screen can we see member co-pays?
F4-4
How do we know if a provider is considered INN?
In the F10 screen, F2-3, must say YAY or NAY
What screen can we see past notes in Webster?
F6-Shift F5- 665
When using p8, in the frequency column, under TYP what do 1,2 or 3 stand for?
1-consecutive mos, 2-per calendar year, 3-per policy year
If there is claim for a crown that is pending for more information, what information might we be looking for?
If initial-xray, prep & seat dates
If replacement-PPD date, reason, new prep/seat dates
Where would we look to see if the member has an office visit copay?
F4 option 4, on the right hand side.
Where would you go to pull the supplemental fee schedule?
Go to the customer service site, click dental office materials and then choose the correct option based on the dental offices state.
What OON benefit information can we not release to a DPPO provider?
The average of the area, RM screens