Are you gonna claim it?
What is the abbreviation for an OON claim?
PNLTY
What is Kaitlyn's favorite tool for checking if WP have been met?
Waiting Period Calculator
What does PHI stands for ____.
Protected Health Information
Private Health Information
Personal Health Information
Kaitlyn's favorite animal is?
A Giraffe.
provider is IIN with both adv and prem, we default to ___ network?
Advantage
What option on the claim do you have to check before you call Kaitlyn for help?
Claim Notes
What is a waiting period?
An amount of time a member has to wait after their effective date before insurance will cover certain services.
No
How many sisters do I have?
Two older sisters
T or F - Waiting periods are subject to deductible?
False - most Waiting Periods are NOT subject to the deductible.
What is an EOP?
Explanation of Payment - Provider EOB
Which department should you call if you have questions about a Waiting Period?
Enrollment
What is all the info we need the provider to verify?
Member ID
Member Name/DOB
Provider NPI
Provider Name
Service Address
What is Kaitlyn's coffee order?
Summit Plus plan uses the ___ network.
Cigna!
What Advanced Menu option can we find the info about the claim payment?
17. Payment/Transaction Info
T or F - you do not have to go over WP's on every dental call.
False - it is required to go over WP's on every call.
The limit for timely filing is__.
12 months from the Date of Service.
What is one of Kristin's favorite activities?
Puzzles!
The frequency for crowns is__.
1 every 5 years
The name of the operation we use to send a claim back for reprocessing.
What would be a time that we might give a member Waiting Period Credit?
If they had a previous EMI Health policy.
Are the majority of EMI’s plans; HMO, PPO, or POS plans?
PPO
4!
The frequency for fillings on the same surface is ____ .
1 every 18 months.