Dental EE - Cluster Doms

History

1

Who was the first president of the Philippines?

Emilio Aguinaldo

2

In which year did the Philippines gain independence from Spain?

1898

3

What was the name of the Philippines' national hero who fought against Spanish rule?

Jose Rizal

4

Which Philippine event is celebrated on June 12 every year?

Philippine Independence Day

5

Who was the Philippine president during the People Power Revolution in 1986?

Ferdinand Marcos

English

1

Who wrote the play "Romeo and Juliet"?

William Shakespeare

2

What is the plural form of "child"?

Children

3

Which punctuation mark is used at the end of a question?

Question mark

4

What is the opposite of "hot"?

Cold

5

The children was/were eating lunch.

were

Music

1

Which American pop singer is known for the hits "Shake It Off" and "Love Story"?

Taylor Swift

2

What was Elvis Presley’s nickname?

The King of Rock and Roll

3

Which band released the hit song "Bohemian Rhapsody"?

Queen

4

Who is known as the "King of Pop"?

Michael Jackson

5

Which instrument has 88 keys?

Piano

50

1

CSC John Renan is educating a caller who wants to know on how to file an appeal for Hard Denied Claim. CSC provided the address where to send the appeal. CSC should also explain to the caller the following information except one, please find the wrong answer.

a. Attach a copy of denied EOB.

b. State the reason caller believes the claim was improperly denied

c. Submit any appropriate comments, questions documents or information

d. Submit review or claim within 160 days

e. State whether caller is requesting a first or second review appeal

Submit review or claim within 160 days

2

Wonwoo is calling to check the status of his claim dos 08/25/24. As per checking the claim was denied and flagged as provider maintenance however, as per original claim the treating dentist information was already updated on MetLife’s system. What should be agent’s resolution for Sky’s claim to be process for its benefits?

• Educate Wonwoo that he needs to coordinate with his dentist and submit additional information needed for his claim to be processed.
• Create a CRC referral to Provider Relations and advice timeframe.
• Create a Screen and Profiles referral ticket to Dental Provider Control Unit and advise timeframe.
• Create a CRC referral to Provider Wrong/Add/Update and advice timeframe.

• Create a CRC referral to Provider Wrong/Add/Update and advice timeframe.

3

Jung So-min is calling on behalf of her dad who is the policy holder. She wanted to know if there is an alt Id he could use for his upcoming dental appointment. Agent has confirmed that there is a PID, and it was also cross reference on the policy holder’s SSN. On the given scenario, are we allowed to disclose the PID to Era?

• Yes, it is because the PID listed was cross reference on EE’s SSN.
• No, it is because there was no verbal authorization provided from EE.
• Yes, because Era is listed as a Dependent on the policy.

• No, it is because there was no verbal authorization provided from EE.

4

What methods of Coordination of Benefits have been applied on the claim below?
Please access the link provided in your email to check for the account details.

• Non-Duplication
• Standard
• Internal COB
• FEDVIP COB

• Non-Duplication

5

What is the payment timeframe for first notice of overpayment?

• 15 calendar days
• 15 business days
• 30 calendar days
• 30 business days

• 30 calendar days

100

1

What is the payment timeframe for first notice of overpayment?

• 15 calendar days
• 15 business days
• 30 calendar days
• 30 business days

• 30 calendar days

2

All information below is correct for the appeal to be process except for one.

1. Attach a copy of the denied EOB
2. State the reason caller believes the claim was improperly denied
3. State whether caller is requesting a first or second review appeal
4. Submit any appropriate comments, questions, documents or information.

5. Submit review or claim within 15-20 business days

e

3

Kang - EE stated that his company is moving from Delta Dental to MetLife Dental, and he had some questions about the MetLife Enrollment. What should the CSC do?

1. Asked for the group/company name to research and follow guidelines for Open Enrollment to determine if MetLife has information

2. Refer caller to HR/Benefit Representative
3. Provide the Toll-Free Number and transfer to TAD
4. Transfer to FSD Billing

• Asked for the group/company name to research and follow guidelines for Open Enrollment to determine if MetLife has information

4

Cindy - EE is calling in for the check information for the claim with DOS 10/13/23. She wanted to know the check number, block number, and billing address or direct deposit information. CSC - Jan investigated the policy and found out that the payment was issued to the provider. What information can CSC - Jan disclose/provide to the EE?

1. Check Number Only
2. Block Number Only
3. Check Number, Block Number and the billing address or direct deposit information

4. Both A and B

d. Both A and B

5

CSC - Yvo was talking to the EE - Yona about a claim. In the middle of their conversation Yona passes the phone to her son for she had something to do. If you are the CSC who handles this type of scenario, what is the first thing you need to do?

1. Verify the name of the son, if on file proceed providing the information about the claim, if not advised the son that you could not provide the information.
2. Continue with the transaction and provided the information they are calling about

3. Deliver the Script for Recorded Line

4. None of the above

c. Deliver the Script for Recorded Line