Oh No You Didn't!!
Forgetting to say this script verbatim, will result in a failed call.
What is the mandated closing script?
Have all of your concerns been addressed?
This is not a bill...I repeat..this is not a bill!! It is the document sent to a mbr/provider advising of determinations made on claims/refs/pre-d's.
What is an EOB? Explanation of Benefits
An extraction was denied due to being previously reported as extracted. You may need to investigate to see if an adjustment is needed. You can check here to see if the correct tooth # was listed.
What is the claim form?
These 2 codes look a like; don't get them twisted! A pano xray is not the same as RCT.
What are 0330 & 3330?
This exp code is trick ricky...you might even think it isn't covered. This service wasn't paid on a fee-for-service basis.
What is N68; covered under capitation?
Sounds to me like you forgot your manners. You didn't use these two soft skill phrases.
What are please & thank you?
We need at least three elements of this...
What is HIPAA verification?
A member calls to change the endodontist they were referred to...You need to do this!
What is a referral adjustment?
This code is used for your REGULAR check up visit with the dentist.
What is 0120-periodic oral evaluation?
Not a covered benefit
What is 27?
You didn't use this feature and the customer heard your not-so-private conversation with your coworker.
What is the mute button?
This does not stand for "Amber Dances Awful" lol; it is an entity that provide clinical guidelines for providers in the United States and promotes the advancement of oral health. You will see this on our claim form.
What is ADA-American Dental Association?
This denied A3, because the mbr/provider didn't reference this when submitting supporting documentation.
What is original claim #?
Sharing is caring...sometimes! These two codes share a frequency and get them teef n gums squeaky clean!
What are 4910 and 1110? Periodontal maintenance and adult prophylaxis.
Pending clinical/consultant review.
What is 19?
You ignored the member, when they told you they accidentally threw away their dentures at their labor day cookout. You were lacking this soft skill! Ain't nobody got time for that! lol
What is lack of empathy?
What is MMIS?
A claim for dentures was denied for frequency, but mbr states they never had them previously. You can check here, before placing an adjustment.
What is service level view?
Code for this can be confused with a periodic oral exam; It is not an exam code.
What is 0210 or FMX?
This duplicate submission code means the determination was applied to this claim.
What is N3?
There was entirely too much of this on the call! Your customer hung up; they thought you were not there. Girl, get off of Facebook!! You're on the clock!!
What is dead air?
I need this or it might be a southern state that I'm in?
What is TX; treatment?
When in doubt, don't bail out! Do this before placing an adjustment!
What is call the assist line?
Ouch! That hurt! Xray code
What is 0274; Bitewing xray?
Miscellaneous; look at the bottom of the claim.
What is exp code 99?