Stars and Rumba
Can we use SFE to verify dental providers
NO
This Procedure involves removing a tooth
Extraction
This type of Dentist handles primary care concerns.
General Dentist.
These procedure will no longer be covered in 2025(except in some Liberty Plans)
Implants
The three types of benefit structures for indiv plans?
MSB, OSB, and Combo
this option is used at the top of the screen to select a providers network affiliation.
NL or NV
This procedure involves removing the nerves and blood vessels
Root Canal
This type of Dentist cares for the Pulp and nerves of a patients teeth.
Endodontist
What type of plan will no longer be offered come 2025?
DMR
This type of benefit structure allows for coverage of all licensed providers, but requires members to submit a form after services. (In 2025 it is no longer available)
DMR
When looking for a provider in Rumba, what screen do we start our search process under
EPDB
Habitual clenching or grinding teeth, usually while sleeping.
Bruxism
This type of Dentist Specializes in the replacement of missing teeth or the repair of natural teeth.
Prosthodontist
This type of plan used to be called the Total Choice plan is now called what, for 2025?
Choice plan
This type of plan does not allow for visits to OON providers.
EPO
Once we found a provider in EPDB, what 4 things do we need to verify before confirming this provider is PAR
Network ID
Product- DPPO
To/From Date- no exp date
No Flags for dental
A removable Prosthesis of the teeth
Dentures
If you you need surgery on your mouth, jaw, or face, what type of dentist would you see?
Oral or Maxillofacial Surgeon
This is the name of the process that our claims and UM team will apply to a claim if they find another level of benefits to pay providers vs the amt they are submitting for.
Alternate Benefit Rule
This type of plan can charge their normal fee, the plans payment is based on the billed amount when seeing an OON provider.
Total Choice or Choice (2025)
What items should we be using STARS for when it comes to dental? List all 3 reasons
A highly trained surgeon usually performs this for conditions affecting the face, jaws, mouth, and neck. we did not know how say to Spanish (or the pronunciation in English)
Maxillofacial Surgeon
This Greek word means "around" and "tooth"
Periodontist
These are 2 totally new plans for 2025
Essential & Enhanced SNP
These types of plan types allow members to go in and out of network for dental providers. (List all 3)
PPO/POS/RPPO