Authorization & Authentication
_____ do NOT need to have an Authorized Representative form on file to call for member PHI
Mothers or Fathers of (unemancipated) minors
PHI stands for.
Protected Health Information
A warm transfer for referrals.
Making a 3-way call to an office and staying on the line to help the member schedule an appointment.
Members 21 and over can receive a cleaning this often.
Once every 12 months.
A document sent to providers to request information before final adjudication.
Resubmission Turnaround Document ( RTD)
This member information must be HIPAA verified.
First and last names, Date of Birth, Benefits Identification Card (BIC) number or social security number.
HIPAA stands for.
Health Insurance Portability and Accountability Act
This many referrals should be given on a call.
Three
This type of tooth can receive sealants as a benefit.
Permanent molars
*members under 21
The Yellow form used to request re-evaluation for payment if services are denied or modified on an EOB.
Claim Inquiry Form ( CIF)
True or False: Members can give one-time permission over the phone to discuss PHI
True: If the member is on the line and verbally HIPAA verifies their information and gives consent, PHI can be released to any caller
MCP stands for.
Managed Care Plan
Name 3 referral resources
Provider Referral Directory,
Dental Clinics Serving Medi-Cal Members
APL (Alternate provider listing)
Medi-Cal Covers these two types of transportation.
Non-Medical Transportation (NMT)
Non-Emergency Medical Transportation (NEMT)
True or False: Once providers receive authorization, they can bill the services on a claim form.
False.
Authorized services must be submitted for payment on the NOA
A medical power of attorney would be this type of representative
Personal Representative
TARNOT stands for.
Treatment Authorization Request Notification
Letter sent to members titled Notice of Medi-Cal Dental Action.
Name at least 3 search options in the provider directory search.
Distance from address, city or zip
County
Specialty
Additional Languages spoken
Show only providers accepting new patient
True or False:
Non-dental services and dental services not covered by Medi-Cal Dental may be used to meet Share of Cost obligation
True
The title of the letter members receive if a treatment is denied deferred or modified.
Notice Of Medi-Cal Dental Action
*sometimes referred to as a TARNOT
This form is used to allow others access to members' PHI.
Authorized Representative Form. Located on smilecalifornia.org
Corro is an abbreviation of this word.
Correspondence (department)
Official name of a pediatric dentist.
Pedodontist
The 3, 4, 5 rule.
Establishing lack of posterior balanced occlusion.
(a way to meet criteria for removable partial dentures)
A NOA is valid for this amount of time.
180 days