Activities
When do we use the "Defer" activity?
When we are either waiting for something or need to allow more time.
A claim is denied due to needing additional information and the information must be submitted with a new claim. What do we do?
See if the information has already been sent. If not, create a NEA with the requested information, override the ICN, input NEA in the edit box. Use the activity "Resubmit New Claim W/ NEA".
How do you change context in epic?
Walk me through how to upload a invoice in onbase..
Import document, choose file, change document type to billing, paper EOB or denials depending on your claim, invoice number, check amount, check number, and claim number
Adults typically have this many permanent teeth..
32
When do we use the "Route to billing resubmission" activity?
When a claim needs to be billed with specific instructions or needs to be sent via paper.
A claim is denied for the patient meeting their maximum. What would you do?
Verify the patients benefits and when they met their max and if the denial is legit send to audit.
What does break-the-glass mean?
You are accessing a PDS employee's dental records.
Walk me through how to find xrays..
Prof Tx Inquiry, PDS Web Viewer
This part of the tooth contains nerves and blood vessels..
the pulp
When do we use the "Route to audit" activity?
When there are no other actions we can take to get payment.
A claim was paid, the payment is posted in the remittance tracker but not posted in epic. What would you do?
Make sure you have the EOB and send to posting review needed.
How do you see if a invoice already has an EOB attached to it?
Prof tx inquiry, click invoice, invoice docs
Walk me through how to find a periochart...
Prof tx inquiry, go to,chart,dental summary, search perio chart
These are the pointed teeth used for tearing food..
Canines
When do we use the "Resubmit Claim"?
When a claim needs to be submitted electronically for the claim not being on file, demographics, coverage updates and needing to submit with the non par date.
A claim is not on file. What would do?
Verify all patients information, coverage information, and provider information. Resubmit claim.
Where do we find a patients benefits overview in epic?
Dental Eligibility
Prof Tx Inquiry, Click correct invoice, Go To, Chart, Chart Review, Procedures.
This dental specialist focuses on straightening teeth
Orthodontist
When do we use the "Route to eligibility WQ" activity?
When we need the insurance information updated in epic and we know the EXACT information it needs to be changed to.
A claim is denied due to needing the patient to call the insurance and verify their coverage information. What would you do?
What information can you find in the coverages tab?
Coverage details, plan type, group number, effective date, relationship to subscriber and etc
Walk me through creating a NEA
Use fast attach on desktop, New search, Input patients information, Search, New Patient,Input information,Add Insurance, Save, Create Attach
This advanced gum disease can lead to tooth loss..
Periodontitis