The ACA and You
Ortho...What is it Good for?
All About Claims
Ace of Base Policy
Deja Vu, Part Two
100
Essential Health Benefits are for these types of people who go to providers in this network.
What are children and PPO?
100
This is the normal way ortho claims are paid out.
What is monthly?
100
This is another term for the Filed Fee Adjustment made by the provider on a claim.
What is a write-off?
100
Posterior composites.
What are white fillings on back teeth?
100
This is a practice that all participating providers are forbidden to do with regard to members.
What is balance bill?
200
The out-of-pocket PPO limit for EHB.
What is $700?
200
This is the IL PPO max for an ortho total case fee.
What is $4000?
200
Reference code 85 states that one or more of these pieces of information is missing on a claim.
What are tooth, surface, quad or narrative?
200
This is the limit for problem focuses exams in a single year.
What is none?
200
Formerly TruAssure, this wholly owned subsidiary of DDIL provides ancillary group benefits such as vision and life insurance.
What is ProTec?
300
The two benefit bands we have in the system for EHB.
What are 0-18 and 19-99?
300
This is the series of codes which encompasses ortho procedures.
What is 8000 - 8999?
300
This is a more common understanding of a provider's status when the claim states they are "Traditional."
What is Premier?
300
This is what we need if root planing and scaling (4341) is done on all four quad on the same day.
What are x-rays and perio charting?
300
This department deals with the recruitment and contracting of dentists with DDIL.
What is Provider Relations?
400
This is the primary reasoning behind medically necessary ortho.
What is providing ortho benefits even if the plan does not regularly cover ortho?
400
This type of ortho is used only in special cases, such as cleft palate or other deformities of the jaw or face.
What is medically necessary ortho?
400
This makes up the third, fourth and fifth numbers of a claim.
What is the Julian date?
400
This is the common thread regarding our policy on sealants.
What is they are covered only on molars?
400
This is the national term used for our HMO network.
What is DeltaCare?
500
Name the six OFF exchange offerings that DDIL provides.
What are Gold/Silver/Bronze, Gold/Silver with Kids Dental Wellness Plus and Kids Dental Wellness Plus?
500
Determine our monthly payment based on the following information: Total Case Fee: $7000 Months of Treatment: 26 % Covered: 50 Deductible: $0
What is $100.96?
500
This amount minus this amount is what the patient is ALWAYS responsible for.
What is Approved minus Allowed?
500
Name two Diagnostic procedures, two Preventative procedures, two Basic procedures and two Major Procedures.
What are x-rays/exams, sealants/cleanings, endo/fillings and crowns/dentures?
500
This department ensures that risk group premiums stay in line with the cost of claims paid.
What is Underwriting?
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