Dental Coverage under your Tricare plan

Below are Tricare Dental coverage and it offers comprehensive dental coverage’s.

· Diagnostic and preventive services (exams, cleanings, fluorides, sealants, and X-rays)

· Basic restorative services (fillings, including tooth-colored [white] fillings on back teeth).

· Endodontics (root canals)

· Periodontics (gum surgery)

· Oral surgery (tooth extractions)

· Prosthodontics (crowns, dentures)

· Orthodontics (braces)

o Note: There are some age limitations to orthodontic coverage.

· Scaling and root planing (deep cleaning) for diabetics at no cost

· Additional 3^rd cleaning for women during pregnancy

TRICARE Dental program provides coverage worldwide & managed with two services area

CONUS Services area includes following places.

United States TRICAREDental Program comes under on CONUS Services area,

District of ColumbiaTRICARE Dental program comes under on CONUS Services area,

Guam TRICARE Dental Program comes under on CONUS Services area,

Puerto Rico TRICARE DentalProgram comes under on CONUS Services area,

U.S. Virgin Islands TRICAREDental Program comes under on CONUS Services area.

OCONUS Services are Includes the following places.

Canada

All other Countries

Island masses, and Territorial waters, as well as civilian ships or vessels outside the territorial waters of CONUS services area, regardless of the dentist’s office address.

Comments

What is QMB / MQMB stands for?

In Medical billing or Healthcare industry The term QMB stands for Qualified Medicare Beneficiary & MQMB stands for Medicare Qualified Medicare Beneficiary. The term "QMB" or "MQMB" on the form indicates the client is a Qualified Medicare Beneficiary (QMB) or a Medicaid Qualified Medicare Beneficiary (MQMB). The Medicare Catastrophic Coverage Act of 1988 requires Medicare premiums, deductibles, and coinsurance payments to be paid for individuals who meet the following criteria: Important: Clients limited to QMB are not eligible for THSteps or THSteps-CCP Medicaid benefits. Note: Clients eligible for STAR+PLUS who have Medicare and Medicaid are MQMBs. Medicaid reimburses for the coinsurance and deductibles as well as Medicaid-only services for the MQMB client. QMBs do not receive Medicaid benefits other than Medicare deductible and coinsurance liabilities. MQMBs do qualify for Medicaid benefits not covered by Medicare in addition ...

Key Performance Indicators (KPIs) for Successful Revenue Cycle Management (RCM) in Healthcare Organizations

Revenue Cycle Management (RCM) is an essential process for healthcare organizations to ensure that they receive timely and accurate payments for the services they provide. Here are some of the key performance indicators (KPIs) metrics that healthcare organizations should track as part of their RCM process: Gross Collection Rate (GCR): This metric measures the percentage of charges that a healthcare organization collects from patients and insurance companies. It is calculated by dividing the total payments received by the total charges billed. Net Collection Rate (NCR): The NCR measures the percentage of expected payments received by the healthcare organization after accounting for contractual adjustments, bad debts, and other adjustments. It is calculated by dividing the total payments received by the total expected payments. Days in Accounts Receivable (DAR): This metric measures the average number of days it takes fo...

Rejection Procedure note qualifier is missing

Need to check the Charges tab and double click on the Procedure Code line to open up the Charge Entry window. There is a Notes section on the right hand side. If there is a note typed, we need to select the type. Need to select field and select the appropriate type of note you are sending. Save the changes made Check all the procedure if submitted many procedure. Save the visit again and submit the claim.

Medical Billing

Search This Blog