DIN or MIN
The KA for Medicare Member: 2024 Dental - Oral Surgery: Medical or Dental in Nature
What is KA 4355?
True or False: Both the member and the provider have the right to file an appeal or claims or Pre-certifications
What is True?
KA used to review with member what all is needed to file a claim with out them having a form to fill out.
What is KA 2778?
The dental phone number is____ and the VDN for DSNP dental is _____.
What is 866-409-0937 and VDN 26117.
(bonus for dental VDN 26117, must provide others)
True or False: There will be no DMR plans in 2025
What is TRUE?
To provide benefits for services dental in nature you must do this.
What is Review Scheduled/Plan benefits in EOC?
Providers can search what website for claim documentation guidelines?
What is www.aetnadental.com?
These are 2 ways member or providers can review their claim statements.
What is via the online portal or we can send a copy to the member/provider as needed?
2 types of Liberty Dental calls all Dental reps can handle.
What are Provider Search and Dental Complaints and Appeals
The new name for Total Choice Plans in 2025.
What is Choice Plans?
To provide benefits for services Medical in nature you must do this.
What is review NPL tool to determine if precert is needed and provider OP medical benefits according to setting?
True or False: Both members and providers may call and request an estimate of maximum fees for Dental Services.
False Members can never call in for estimates when it comes to dental
4 types of claims forms for Aetna PPO Dental Network
What are the ADA form, Super Bill, Aetna Dental Claim Form, Medicare Reimbursement Form?
True or False: When speaking to a provider they can be authenticated under the member profile.
False. They have to have the member in the office in order to speak under the member profile.
True or False: All Dental plans will have a fee schedule in the EOC for 2025
What is True?
For Oral surgical codes determined Dental in nature, providers may request this.
What is submit a Pre-determination?
If a predetermination has a processing error.
What is, it can be sent back for review?
Timely filing for dental Claims
We encourage members to submit reimbursement requests within 365 days, (payment cannot be promised after 365 days.)
Liberty Dental Services these 5 states.
CA, FL, NV, NY and OK in 2025
(CA, FL and NV only in 2024)
Services in 2025 that have been reclassified as preventative.
What are Full Mouth and Periapical X-Rays?
Extraction Codes in this range are always considered dental services as simple extractions
What are codes between D7111 and D7140?
To submit a predetermination provider or member's must do this.
What is mark off the section on their claim form that says this is for a pre treatment estimate?
The timeframe to rework a claim is ___ days. The time frame for the member to receive a corrected EOB is __ days.
What is 30 and 60 days?
Do this anytime you discuss locating a dental provider with the member.
What is review provider disclaimer?
2 new dental plan types in 2025.
What are:
Essential (no frequency limits/billed OON)
Enhanced (frequency limits/billed OON)