dso-eligibility
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{{preloginError}}
  • {{memberinfo.memberProfile.personName.firstName | uppercase}} {{memberinfo.memberProfile.personName.middleName | uppercase}} {{memberinfo.memberProfile.personName.lastName | uppercase}}
    {{memberinfo.memberAddress.postalAddress.addressLine1}}
    {{memberinfo.memberAddress.postalAddress.city}},{{memberinfo.memberAddress.postalAddress.state}} {{memberinfo.memberAddress.postalAddress.zip5}}
    DOB
    {{memberinfo.memberProfile.dateOfBirth | date: "MM/dd/yyyy"}}
    Relationship
    {{memberinfo.memberRelation.codeDesc | uppercase}}
    Spoken Language
    {{memberinfo.lapAndHcrInfo.spokenLanguagePreference}}
    Language Assistance
    Yes No
  • Provider Network Status
    {{memberNetwork}}
    Subscriber ID
    Product ID
    {{memberselected.eligibility.product.codeValue}}
    Product Type
    {{memberselected.eligibility.productPlanType.codeValue}}
    Group ID
    {{memberselected.groupId}}
    Group Name

    {{memberselected.groupName}}
    Product Line
    {{memberselected.eligibility.plan.codeDesc}}
    Effective Date
    {{memberselected.eligibility.memberEligibilityEffectiveDate | date: "MM/dd/yyyy"}}
    Plan Year Begins
    {{memberselected.eligibility.planYearBeginDate}}
    Eligible
    {{memberselected.eligibility.eligibilityIndicator}}
    Essential Health Benefits
    {{memberselected.ehbIndicator}}
    Term Date
    {{memberselected.eligibility.eligibilityTermDate | date: "MM/dd/yyyy"}}
    Product Description
    {{memberselected.eligibility.product.codeDesc}}
  • Provider Location
    {{PprovAddress1}}
    {{Pcity}}, {{Pstate}} {{Pzip}}


    Assignment Status
    Assigned Dentist : {{dhmoMessage}}

Dental Account Summary

{{memberNetwork}}
Annual Maximum Benefits - Dental
Deductible
Lifetime Maximum Benefits - Orthodontics

Benefit Details

Procedure Category Procedure Category Description Coverage({{memberNetworkShort}}) Deductible Applies Waiting Period Met Date
{{onceData.procedureCategory.codeValue}} {{onceData.procedureCategory.codeDesc | uppercase}} {{onceData.coveragePct}}% {{onceData.deductibleApplies}} {{onceData.waitingPeriodMetDate | date: "MM/dd/yyyy"}}N/A
ADA Code ADA Description Procedure Category Service Dates Service Date Procedure Code Frequency* (i-ii-iii) Age Limit Alternate Benefit Related Codes
{{historyData.procedure.codeValue}} {{historyData.procedure.codeDesc}} {{historyData.procedureCategory}} {{historyData.services[0].serviceDate == null || historyData.services[0].serviceDate == ""? "-" : historyData.services[0].serviceDate | date: "MM/dd/yyyy"}} {{historyData.services[1].serviceDate == null || historyData.services[1].serviceDate == "" ? "-" : historyData.services[1].serviceDate | date: "MM/dd/yyyy"}} {{historyData.services[2].serviceDate == null || historyData.services[2].serviceDate == ""? "-" : historyData.services[2].serviceDate | date: "MM/dd/yyyy"}} {{historyData.services[3].serviceDate == null || historyData.services[3].serviceDate == ""? "-" : historyData.services[3].serviceDate | date: "MM/dd/yyyy"}} {{historyData.inNetworkFrequency != null && historyData.inNetworkFrequency != undefined && historyData.inNetworkFrequency.length>0 ? historyData.inNetworkFrequency : historyData.outOfNetworkFrequency != null && historyData.outOfNetworkFrequency != undefined ? historyData.outOfNetworkFrequency : 'NA'}} {{historyData.ageLimit == null || historyData.ageLimit == "" ? "NA" : historyData.ageLimit}} {{historyData.alternateBenefit == null || historyData.alternateBenefit == "" ? "NA" : historyData.alternateBenefit}} {{historyData.relatedCode == null || historyData.relatedCode == "" ? "NA" : historyData.relatedCode}}
* Frequency Definition: i = Number of Procedure (999 = unlimited); ii = ProcedureFrequency Type (C=Calendar Year, F=Floating, P=Plan Year); iii = Period and Timeframe(D=Day, M=Month, Y=Year) Example: 1 F 36M read as 1 Procedure per 36 Floating Months
Subscriber ID Amount Claimed Claim Status View
{{item.member.memberId | maskNumber}} $ {{item.totalCharge}} {{item.claimStatusCode.codeDesc}}
{{treatmentPlanList}}
Date Last Edited Treatment Plan Name Member Name View Plan
{{item.lastUpdateDate | date: "MM/dd/yyyy"}} {{item.treatmentName}} {{item.memberName}} Details
Link to copay schedule

Claims Address Payor Id:
UNITED HEALTH CARE DENTAL CLAIMS PO BOX 30567 SALT LAKE CITY, UT 84130-0567
521337971