authorization to clinic immediately after received call from member. Fax’s record as below. (The approved treatments are scaling, prophylaxis and routine checkup)
- Clinic sent treatment plan (Fillings) for next schedule to Cynergy on 6 Sep 15 at 6:30 pm, Cynergy sent out questionnaire to clinic on 7 Sept 15 at 10:38 am to verify if treatment plan is covered or fall under any exclusions.
- Clinic sent reply in regards to dental questionnaire to Cynergy on 9 Sep 15 at 6:48 pm.
- Case was approved on 9 Sep 15 at 7:50 pm. Cynergy contacted member in regards to the approval and ask when the convenient schedule to see the dentist for the 2nd appointment is. Member prefers to see the dentist on 20 Sep 15, Cynergy acknowledged and will confirm the appointment schedule once is sorted with clinic.
- Cynergy contact member on 10 Sep 15 at 6:10 pm (the earlier attempt was failed) to inform that P2D status has not been updated yet. Member argued that her credit card bill already been deducted, Cynergy took a note and inform member that will recheck this issue with head-quarter once again.
- 15 Sep 15 at 2:23 pm, ACE replied to Cynergy by written email that P2D of this member still not been updated, cashless service cannot be provided until status will be changed.
- Cynergy informed member according to the provided information by ACE, member confirmed that her credit card status is still active, Cynergy recommended member to contact ACE for greater information of credit card cut-off time.
- The reason cannot provide cashless service to his member is “Paid to Date status 20 Aug 15”
Solutions: Provider team will refresh and emphasis the related operation workflows for
Dental network providers and their staff again.
Paid to date issue – Please ACE kindly advise Cynergy on how to handle this
issue in the future.