PPO/HMO
The BCB for all name brand or premium restorations for PPOs.
What is the porcelain option or lab fabricated option?
When coordinating, it is essential that you enter the appropriate information in this section of the treatment plan in order for the correct fees to populate. The information entered here will also populate in the treatment plan follow up WQ.
What is the requested info tab?
This is required in the subject line of your email, when sending any PHI via email to an outside organization or outside of pacden.com.
What is [secure]?
The number of days that you need to minimally be prepped for and pre-reg completed.
What is 3 days?
Johnny has a 2/12m frequency for exams and has a PPO that runs on a calendar year. He had a CCX exam on 2/1/2024, ER exam on 5/4/2025. His insurance has coverage for an exam on what date?
What is 2/2/2025?
You click on this icon on your hyperspace toolbar to document any clinical conversations with a patient.
What is the telephone call icon?
The $59 for the NP special, gets applied to this procedure?
What is the Hygiene procedure?
(prophy, PMV, Gingival Scale, 1 quad of SRPs)
We believe patient's pay our ___________.
What is Salaries?
This term references, when a PPO carrier pays on a downgraded material and not the actual procedure being preformed?
Example: Insurance pays and downgrades to an FMC for a Posterior Porcelain crown.
What is a Alternative Paid Benefit?
In this WQ you will find ALL pending treatment that hasn't been completed or scheduled and needs to be followed up on?
What is the treatment plan follow up WQ?
Patient's scheduled for specialty can sign consents up to this many days in advance.
What is 7 days?
This needs to be attached to every appointment with a specialist in order for provider to be aware of what they are seeing the patient for and what needs to be treated.
What is a Clinical Specialty Referral.
For HMOs, this is the industry standard on determining the cost of optional/alternative restorations to patient's when they choose to go outside their BCB.
What is OTF, or Optional Treatment Formula?
This icon/activity in the Guarantor account will allow you to view any financing receipts like SGF, SmartPay.
What is Guarantor Docs?
After having a conversation with a patient in regards to a balance, this is where you would document the conversation and view it for future reference.
What is Guarantor notes and the View History tab in the guarantor account?
The first email confirmation for all appointments is sent ____days in advance.
What is 14 days?
This reference tool tells you how and if an insurance carrier will pay if a provider is not credentialed, as well as proper verbiage on how to speak to patients when a provider is not credentialed.
What is the Out of Network Maximizer?
When accounts are in this WQ, they need to be reviewed for errors that would prevent the production from being recognized and need to be corrected before a claim is sent.
What is Charge Review?
This metric on your My Office Page, ensures that you will have full schedules in 6 months.
What is CCX booked?
When verifying DE, RTE stands for ____________.
Real Time Eligibility