EX Codes
777
What is there is a limit on the number of times we can pay for this treatment in a calendar year. That limit has already been reached. You are responsible for payment. Please read your Evidence of Coverage for more information?
How quickly do expedited cases need to be completed?
What is 3 days?
HCKEC DETRIV
What is check divert?
Who is our current CEO?
Who is Mike Castro?
Provider is disputing his contract effective date
What is Denial of Provider Services (Non-Medical), credentialing?
FLX
What is this treatment is covered, but it is limited to how often it can be done. That limit has already been reached. Network dentists agree to charge only a set amount. If you see an out-of-network dentist you have to pay more?
Provider case, claims comes in for 2021, what handbook do you attach?
What is the 2021 Dentist Handbook?
EANLABC LOBINLI
What is Balance Billing?
What year was Delta Dental founded?
What is 1954?
Claim has already been reviewed by a clinician
What is medical necessity?
206
What is there is a waiting period between when your coverage and when you can have this service. That period has not yet passed. You are responsible for payment?
Ensure you are corresponding to the correct person that filed the dispute
What is HIPAA?
CNIEEVED FO GOCEEAVR
What is Evidence of Coverage?
Husband called in to file a complaint on behalf of the wife, what must we have on file?
What is AOR?
Member is disputing the amount being reimbursed on a bill
What is coverage dispute, billing dispute / balance billing?
5HD
What is this treatment is covered, but it isn’t covered if when you have dentures. You are responsible for payment?
If the decision to overturn the initial determination resulted from misinformation communicated to the appellant
What is pay and educate?
CRLEASOF
What is Alfresco?
A call comes in, what information should you be verifying before speaking with the caller?
What is callers first and last name, date of birth, enrollee id # and enrollee date of birth.
A dispute over an excluded service or excluded coverage
What is Coverage Dispute, Exclusion, Contract Exclusion?
510
What is services denied for wear, attrition, abrasion?
How do we ensure all issues are being addressed
What is listening to the call and/or contacting the appellant?
AHARS IHARAACVR
What is Sarah Chavarria?
Dad is calling in on behalf of his adult dependent 25 year old child, what is NOT ok to share?
What is treatment history and claim details?
Member is complaining about her interaction with the front desk in her dental office
What is Quality of Service?