How do I what am I Supposed To Do?
What records do we request for evidence of a dirty office or instruments, and whom do we request them from?
Member, photos
(Quality of Service) The member called Delta Dental on March 23rd, to file a complaint about the rude service received on February 28. What is the incident date?
February 28
This doctor has appeared on Oprah, thinks breakfast is a joke, that you should eat brunch instead, and is currently serving as an administrator for CMS.
Who is Dr. Oz?
Manager
up to $5000
What form of outreach MUST be done in the first RFI attempt?
Verbal and one of the following: email, mail, or fax
What department do we email when we find errors with Provider Information on our website?
Provider Concierge at providerconcierge@delta.org
This issue occurs when a case is retrieved using the "Get Next" function but no immediate action is taken to begin building it.
What is a delay in case build after assignment?
Instructor of spin classes – Manager of Dental Consultants for Delta Dental
Who is Dr. Green?
Director
Up to 25k
This practice involves documenting all actions and research conducted in real-time, regularly reviewing cases until resolution, and ensuring transparent communication through timely notes in the case Notes section.
timely case follow-up
This term refers to the availability of healthcare providers who have agreements with insurance companies to offer services within a specific geographical area.
network adequacy
This is the queue for manager approvals.
What is G&A WROF Approval?
This doctor was a child prodigy
Who is Dr. Doogie Howser?
VP/GVP
up to 50k
When does the clock start regarding timely case movement?
The timeframe starts on the date that the case was assigned or pulled from Get Next.
What is the standard rule drafting format?
policy document, page number, section name, and subsection (if applicable), and include the rule verbatim.
This critical step in case management, involving gathering insights and evaluating information, is often overlooked
What is research and analysis?
This doctor also appeared on Oprah, and if you have ever seen this man on this show, you know that whoever is the guest on the show is about to have an intervention.
Who is Dr. Phil?
SVP/EVP/CFO
Up to 150k
In non-CMS standard processing for post-service and quality of care, this is the timeframe for the first attempt to request outreach for records.
2 business days
This process is initiated internally and includes Independent Examiner processes when a Delta Dental Consultant determines a clinical evaluation is necessary to assess the quality of treatment related to a member complaint.
What is external peer review?
This is the hashtag used for providing commentary in cases involving the Language Assistance Program.
#COFEEDBACK
“You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose.”
Who is Dr. Seuss?
President/CEO
anything over 150k
What is the number of “business days” required to demonstrate timely case movement for CMS and Non CMS?
3 business days for CMS, 5 Business days for Non-CMS