Module 2- Providers Assessment

One of the requirements of being a Star designated provider is the office must do amalgams in their office if their office performs restorations.

Providers within the ADDP Dental Network that have a Star designation will NOT have a different fee schedule than providers that are just participating with the ADDP Dental Network.

The ADDP Dental Network is represented by the network code 99.

To submit a claim through a referral or authorization in DART, it is necessary for at least one line on the referral to be open or for the authorization to have at least one line with DSPOC Approval and a line status of open. This means that there needs to be an active and valid referral or authorization in place for the claim to be processed successfully.

It is possible for a provider that is not participating with other United Concordia networks to become participating with only the ADDP Dental Network.

To maintain their Star designation status within the ADDP Dental Network, an office must submit at least 90% of their ADDP claims electronically, submit authorizations electronically via DART, and receive their United Concordia claims payments via EFT (Electronic Funds Transfer). This means that all of the options listed must be done by the office in order to maintain their Star designation status.

Star designated providers can be identified in two ways: a star will show beside their name and they will appear at the top of the find a dentist list. This means that they will be visually distinguished with a star symbol next to their name and they will also be prioritized at the top of the list, making it easier for users to identify and choose them.

The provider can submit a claim to ADDP with the new enhancements through various methods. They can submit it through DART by going into a referral or authorization, by using Speed eClaim, by mailing the claim, or by submitting it electronically. Therefore, the correct answer is "All of the above."

The given statement suggests that when making an appointment for a referral for an ADSM with a provider's office, we should inform the office that they can now file their claims through the referral modification screen in DART Plus. This implies that it is important to communicate this information to the office so that they are aware of the new process for filing claims.

A Star designated provider does not have a higher fee schedule allowance for procedures compared to a provider who is participating with the ADDP Dental Network only. This means that the statement is false.

All of the above options are ways in which a provider's office can request an appointment control number. They can request it through the Interactive Voice Response (IVR) system, by accessing the website, or by speaking to a representative within ADDP.

Star designated providers are required to receive their payments for claims via electronic funds transfer (EFT). This means that they cannot receive payments through other methods such as checks or cash. EFT is a secure and efficient way to transfer funds electronically, ensuring that the payments are received by the providers in a timely manner. By mandating EFT for star designated providers, it helps streamline the payment process and reduces the risk of errors or delays in payment.