Skygen
This box on the eligibility tab will confirm the Initial Benefit Effective Date
Other Info 2
These are the two types of PPO plans
Passive and Active
In Compass, the __________ selection can be used to confirm the eligibility period of a dental policy.
Cafeteria
Timely Filing Limit
365 days
Is there a missing tooth clause in our plans?
No
I can look under this tab to check the max remaining and deductible
Accums
These 3 states currently offer EPO plans
AZ, CA, NV
When using Employer Access you find the policy booklet under this tab
Documents
If the service is non-covered, does discounted PPO fees apply?
No
These are the tooth restrictions for sealants
1st and 2nd permanent unrestored molars only
Provider can register on Portal this 3 ways
Provider, Location, Payee
This is the stacking order for the networks we accept
Dentemax
Dental Health Alliance
Careington
Connection Dental
Premier
Maverest
First Dental Health – EPO
In GSAP, this report can be used when faxback is not available to quote benefits
Other Provisions Report
Are temporary crowns covered?
No, we only consider the allowance for the permanent crown.
Do you accept assignment of benefits to a non-participating provider?
We will accept the assignment of benefits from a non-participating provider.
These 2 reports can be used to look up a code's coinsurance and frequency
Benefit Plan Detail Report and Product Detail Report
Healing period after SRP before D4910 Perio Maint
90 or 91 day
In GSAP, under Categories View, you can open this folder to check if a member is registered for dental benefits with this group.
Census/Enrollment
Can you send me Dentemax fee schedule?
How is Ortho considered?
25% of the Total Case Fee is considered for the placement date. The remaining TCF is divided out over the estimated number of treatment months with monthly benefits automatically generated by the system.
This tool can assist you in creating a follow up
Follow up Pathway Tool
In order to quote benefits you will need to verify at least 3 of the following for HIPPA
Name, date of birth, social security number, member ID, address
In Compass, I can click on this Icon to confirm when we updated the eligibility date
Magnifying Glass
Are Invisalign braces covered?
Invisalign braces are considered under the plan. However, Smile Direct or any sort of braces that are not rendered at a dental office are not considered.
Provider is asking if an exam and a cleaning can be done the same day
BUNDLING QUESTIONS