Cowboys
Where will you be able to view a dental pre-cert and what will the type be listed to indicate dental?
On the precert tab, Dental
What is an occlusal surface?
This surface is the flat chewing or grinding surface
We will only do a PD for what type of dental procedures?
Anterior crowns and veneers
When pulling any dental history in C search, where should you put the procedure code to help you search?
You will use the procedure on the left side
Under a medical contract, what category would indicate if there were any dental benefits under the medical contract? (HINT: 4 letters)
DENT
What are Periodontic services?
Treatment of the gums
Before quoting any dental benefits, you must first check for what?
The dental rider
What is the limit for a bitewing x-ray?
2 per benefit period
Do you need to provide the history on every dental call?
Only when the member ask.
What information do you put in the first Inquiry box?
Verifiers, and Questions
True or False: On dental claims, the A3/A4 savings will always be a write-off?
False, on dental, the A savings will always be the patient responsibility.
How often can you have a Panorex X-ray?
2 every 36 months
Where would you find the NPI number for a Provider?
Find a doctor or NPI Locator in google, or call the provider
Will the pay as procedure T4/R4 savings be the patient responsibility?
Yes, the R and T savings will always be pat responsibility.
What is the age limit for a child to receive dental benefits under the health contract?
19th birthday
What is the GO TO Category for Anesthesia?
ANES
What are the verifiers?
First and last name and DOB
How many riders does the DenteMax contracts have?
3
(U,P,9)
Where would you go to see the fee schedule for Dental Pricing?
PAL: The pricing tool in CIS (looks like a dollar bill)
How are the extra teeth numbered if an adult has more than 32 teeth?
? It is coded by the provider using the tooth closest to the extra tooth and given the letter A for a permanent tooth. i.e. 7A.
How are adult teeth identified?
By numbers
What is the GO-TO CATEGORY for DENTAL
DENT
Are the front teeth known as anterior or posterior?
Anterior
How many quadrants are the mouth divided by?
4
How are baby teeth identified?
By letters