A Complete 360
This claim color in Service 360 represents a claim that has been denied in the system.
What is Red
This special plan reimburses the member the first $100 at 100% and the remainder of claims at 50% until it reachs the $1000 maximum
What is Direct Reimbursement
This CDT code is the most common code for adult prophylaxis
What is D1110
Medicaid is always the…
What is the Payor of Last Resort
This DDCO product offers the broadest choice of providers giving our members the most savings.
What is PPO plus Premier
The D: is used to precede which type of member number search in Service 360?
What is Date of Birth
This DDCO plan is a Medicare-related plan with thousands of seniors enrolled
What is Kaiser Senior Advantage Medicare
This CDT code is for a periodic oral examination for an established patient
What is D0120
This rule dictates the COB when there are 2 natural parents covering a child on their own plans
What is the Birthday Rule
This product helps with diagnostic and preventive visits and doesn't count against annual maximum.
What is Prevention First
This box in Service 360 needs to be unchecked to send the issue on to another department to work
What is the "Mark as Closed" box
This plan reimburses Premier providers at the PPO rate, passing along the difference to the member.
What is MAC plan (Maximum Allowable Charge)
This CDT code is used for Periodontal Maintenance
What is D4910
If a patient is a subscriber on both an employer plan and a COBRA plan from a past emploer, the COBRA plan is:
What is Secondary
This product feature allows for 100% coverage on all procedures for the children up to their 13th birthday
What is Right Start 4 Kids (RS4K)
The accumulators for a member are located on this Service 360 tab
What is Plan Summary
This type of plan is restricted to PPO dentists and follows specific fee schedules for the group (and not percentages of coinsurance)
What is EPO copay plan
Implant services codes are found within this range of CDT codes
What is D6000-D6199
This document is needed to process COB claims when Delta Dental is considered secondary.
What is EOB (Explanation of Benefits)
Members using Patient Direct must have this updated in HealthEdge / Payor to reflect their chosen primary dentist
What is the Office ID
When searching in the "Search By" function within the list of claims for a member, these are the two ranges that can be searched
What is the Service Code Range and Date of Service Range
This plan could be considered more of a savings plan where the member pays at the time of service.
What is Patient Direct
This CDT code is for the Comprehensive Ortho Treatment for an Adolescent
What is D8080
In Service 360, if a plan is able to be coordinated with another plan, the COB Calculation status is listed as:
What is Allowed
This is a provision in contracts allowing members with various conditions extra cleanings in a contract year.
What is EBD (Evidence Based Dentistry)