Eyes and Mouth -Week 1 and 2

My workflow

100

This article shows guidelines and list of luxottica stores 

Cole (Luxottica) Retail Store Guidelines

200

This article provides details on how to authenticate provider's and members  

Verification Quick Reference Guide

300

I am able to view steps on accessing the public folder and also claims address and email address is seen here

Claims Tips and FYI

D/V Claim Submission Process

400

Once a provider ask about replacement of a tooth prior to coverage, this article will assist

Missing tooth clause

500

This article gives an outline on how to use claim processing guide based on the plan design and also what columns best suits the plan 

Claim processing guide cheat sheet

Do I really know

100

I can be used as an alternate to the NPI

TaxID 

200

The number is provided to Luxottica Cole retail stores  

Cole conversion #/ Eyenet # 

300

Timely filing limit

1 year (12 months)  

400

This is accepted by Unum however it's based on the signature on the claim form  

Assignment of benefits 

500

Use me to view providers that are not populating in Skygen 

NPI registry 

Lets talk dental

100

Group # for colonial plans 

CLAW01

200

This type of plan is purchased directly from unum by the member not through a group or empployer

Legacy individual plans 

300

Once a member completes 1 cleaning and exam, they qualify for this 

Carryover benefits

• A member must be on the plan for at least 3 months.

400

After 30 days and claim was not updated in Skygen however in public folder what should we do?

Escalation/ follow up

500

These claims must be submitted manually, monthly/quarterly

Ortho

I can see clearly now

100

T/F All vision plans are Active PPO 

True 

200

This type of lens option may have an age limitation up to 19

Polycarbonate lenses

300

This statement/phrase must be advised when discussing contact lens and glasses/frames during the same period

In lieu 

400

This is also known as Bifocal lenses

Progressive lenses 

500

This is Unum's proprietary network/ fee sch for Vision provider's

FLVN- First look network

Miscellaneous

100

This is the limit set for the number of codes a DVBA can assist with

10 procedure codes/description 

200

This folder is used to check for claims submitted to correct email or fax number but not seen in Skygen 

Public folder 

300

January 4,2025 through to January 3,2026. What type of period/ yr plan is this 

Benefit or Plan year 

400

I am third on the hierarchy based on the fee scheduleDMX, Dentemax   

Maverest 

500

Provider's address is ACB(unum dental fee sch) and would like a copy of their fee schedule, what would be the appropriate step?

Follow up in Skygen to Provider Advocate