Dental Benefits

Dental Benefits

• Parameter-driven set-up routines that enable you to quickly and easily create plans, which can be unique to a specific group or block of individuals, or shared between groups and individuals.
• A user-defined "association" field that gives you the flexibility to group insureds in different books of business for more efficient management and reporting.
•  Flexibility in rating, which may be established from user-defined tables, composite unit rating, average rating, or manual rating.
• Automated billing routines with the flexibility to generate list bills, individual direct bills, summary bills, self bills, and EFT. Billings can be created in either real-time, or in an after-hours "batch" type process.
• The capture of your agent and broker information for reporting and/or commission calculation. The system provides an array of user-definable flat and graded calculations, with up to 9 override levels and multiple splits among all tiers
• On-line, real-time inquiry. Authorized users are able to obtain accurate, up-to-date information concerning any primary insured or dependent, at any time, from actual data tables, rather than from a potentially outdated download

Claims Capabilities
Our comprehensive dental claims system provides the special features you need to increase accuracy and efficiency, including:

• User defined deductibles, coinsurance, co-pays, maximum age limits, benefit waiting periods, and other policy provisions for routine, basic, major, or other service-types.
• User defined service code parameters for diagnostic, preventive, restorative, endodontics, periodontics, prosthodontics, prosthetics, surgery, othodontics, or other dental services.
• Free-form service code messages displayed during the adjudication process as critical alerts to the analyst.
  Capture of pretreatment estimates, allowing a claims assistant to establish the description of proposed dental services, and route forward. The treatment plan can then be reviewed online, followed by the generation to the attending dentist of a per-service allowance estimate or a stipulated alternative treatment plan, if applicable.
• Capture of submitted claims or pre-estimates in a pended status, allowing you to track reported claims or pretreatment requests, and monitor production statistics while investigation efforts and certification are under way.
• A correspondence module that gives you the flexibility to establish user-defined letters, follow-ups, duplicate coverage inquiries, and dental pre-authorizations. Pending reports with aging assist you in tracking the status of any claim that has been pended for additional information, other carrier EOB's, or the dentist's certification of the completion of services.
• Capture of the place of treatment, accident indicator, secondary carrier, and other data critical to the adjudication process.
  Personal claims accumulation records that are updated only as actual pre-estimated services are performed. Pre-estimated services not performed will remain in a pended status, available for inquiry and future adjudication.
•  Provisions for dual- and triple-option dental PPO/EPO capabilities, giving you complete flexibility to link benefits to a preferred or exclusive provider, and increase or reduce both benefit allowances and plan provisions based on point-of-service.
•  Full tooth chart capability with the maintenance of a complete dental history including claims that have been processed for each tooth, surface, full mouth, etc.
• The flexibility to combine benefits and deductibles under a common accumulator with medical plans, while maintaining separate dental and medical plans in the system.
• Automatic repricing of fees charged by network dental providers even for providers participating in multiple networks.
• Accommodation for two different usual and customary tables simultaneously, including Ingenix/MDR or any user-defined table you wish to build. 
• Seamless, real-time integration with our administration system so the current eligibility status of each insured is recognized immediately as changes are made. Conversely, administration staff are instantly aware of claims processed even minutes prior, when researching for backdated coverage termination. 
• User-defined cause codes (three-digit alphanumeric field) that let you classify claims activity in a meaningful way, and report on all your claims experience.
   
  A special suite of dental provider and service claims analysis reports in addition to ad-hoc capabilities.