Benefits and Eligibility

Question 1

what is the accumulation period for maximums?

Answer 1

1/1/2019-12/31-2019. Can be found in EBD it means….

Question 2

How can I tell if it is a standard or straight PPO?

Answer 2

Basis of payment in EBD. Table called other provisions.

Question 3

Can I get a partial with a missing tooth clause?

Answer 3

if it says N/A means there is not a tooth clause and get dentures. If it has a tooth clause then no dentures.

if has prior extension then if they have the clause yes they get dentures. If they have prior exentsions then they do not get dentures.

Question 4

are posterior composites covered?

Answer 4

if they are not covered in the plan, we can make an allowance for the amalgam rate.

Question 5

look at the limitations for when looking on EBD for procedures

Answer 5

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Question 6

what is inital exam code-

what is periodic/oral exam code -

Answer 6

what is inital exam code -0150 1st PA

what is periodic/oral exam code -0120 2nd PA

Question 7

According to the provider handbook if provider took 4 bitewings and 2 bitewings what do the PA become?

Answer 7

If they took 4 bitewings and 2 bitewings and PAs. Then the first film becomes 1 st film.