My workflow
I can provide you different methods on how to submit a claim
Claims tips and FYI or D/V Claim Submission Process
This is where I log my dispositions once the call come on my line
AWS
All orthodontic benefits will pay 35% of the Orthodontic Lifetime Maximum on the Initial Banding Claim? T/F
False
What dental produce does not coordinate benefits?
Orthodontics
Once a follow up is still pending, this color will show in skygen
Red
Will show the ortho codes and claim filing details
Ortho Benefit Guidelines
I check settlement status, transaction method in this tool
VPAY
This vision policy is not handled by unum
EyeMed
Downgrade is a term we never use. what is the term that the DVBAs should use
Alternate benefits
What is the typical Orthodontic Code for the Initial Banding Claim?
8080
Fee schedule hierarchy and contact #s can be viewed on this article
Request for Fee Schedules (OON or Network Contracted)
Once the claim is mailed, email or faxed I can view the claim image here
Claim view/ DAPS
This term refers to benefits that are not payable to replace a tooth that was extracted prior to coverage
missing tooth clause
You are able to transfer members to P&R department
T/F
False
Provider discount can apply to services rendered
If the benefits are exhausted for covered services - Provider discount applies
Covered services
This article gives the guidelines for HIPAA and provider and member authentication before accessing information
Verification Quick Reference Guide
You much use me to provide the eyemed # to the provider for filing claims
Cole conversion number/ eyemed or eyenet number
What is Unum's Coordination of benefits?
Standard
You can find these policies/ group by entering 9ehop
Legacy individual plan
What must include with the first monthly treatment claim for a Work in Progress (WIP) Orthodontic Claim?
Prior EOB
Once you identify the group name, I can be used as a guide on what should be places in portal admin and also what column to read from on claims processing guide for all policy types
Processing Guide Cheat Sheet
What is the limit for procedures/descriptions when reviewing tooth history
No limit
T/F Vision provider calls to get information on member's vision plan however only a dental plan is found. We should advise the provider there is no vision coverage and end the call
False- We refer to EyeMed
Once PHI has been breached this type of ticket should be filed
RADAR
Third Party Partner contracted with Unum Dental & Vision to recommend benefits and course of treatment
P&R