insurance Flashcards
what to verify with financial services before seating pt
- insurance coverage?
- is procedure covered
- treatment waiver
- pre-auth
what is the only company contracted with the dental school
delta (everyone else is out of network and you have to pay up front)
how long does pre determination take for large treatment plans
6-10 wks
which agency insurance makes you pay 3 bucks
medicaid
t/f agency insurance must be verified once a month
true
is prevident covered by agency insurance
yes if you have written for generic
t/f regardless of whether a treatment is covered or not, prior authorization are required to get a procedure covered/paid for by the insurance
t
what do you need for SRP pre auth
PA, probing depths 4-5. FMX desired, 4x bw and ant PA also ok
are RUC/crown build ups covered
no, and should not be billed as a large restoration
what procedures need preauth
dentures, RPDS, post and core, anterior crowns, retreat endos, ortho, SRP
how long does It take to get pre auth, should you schedule pt
around 30 days and no
t/f prior authorizaitons are good forever
false they expire, only valid while patient has active coverage
should you verify coverage at each appointment
yes
dental procedures can be coded as medical necessity
FALSE
you should say “YOU NEED TO HAVE THIS DONE”
no say we recommend it
when are pre-d’s done
commercial insurance coverage
do pre-ds guarantee payment
no, knowledge purposes only
does the college honor most pre-ds
yes, so pt only has to pay copay and deductible
what is the turnaround time for pre-d’s
4-10 wks
do our denture fees include hard reline
no, tell pt they will probably need two and include It in tx plan
when do you use treatment waivers
when a pt with agency insurance is requesting to have a non covered procedure performed and the pt decided to move forward with tx before pre-authorization. pt pays out of pocket.
how long does PAAR take
7-10 days
where should you take PAAR forms
shelly in billing not office admin
