|
Articles
Delta Dental Receives `AA-` Rating from
Standard
& Poor's
Golfers Raise $55,000 for Special Olympics
Mark that Date!
New Jersey Adopts Tough New Insurance Fraud Law
Delta Dental Receives High Ratings from Benefits
Managers Annual Survey
Caucus New Jersey Videotape on Oral Health Available
Visit Delta Dental at Atlantic City Conventions
"View Log" Feature Creates Paper Trail for Eligibility Submissions
Info Kit for Benefits Managers Available
AADC Honors Dr. Navarro
VanBrunt Re-elected DDPA Chairman
DeltaCare Section of Web Site Enhanced
HIAA Offers Live, Online Training Programs
Staff Spotlight: Pam Haddock
Standard & Poor's recently affirmed Delta Dental
Plan of New Jersey's AA- counterparty credit and financial
strength ratings for the fourth consecutive year. The
analysis was based on the company's extremely strong
capitalization, excellent earnings and good business
position.
Standard & Poor's predicts a stable outlook for Delta Dental, New Jersey's
and Connecticut's leading dental benefits carrier.
"Four years of high ratings from Standard & Poor's validates the merits of
our extensive dental provider networks and our approach to quality and customer
service," said Delta Dental President and CEO Walter VanBrunt. "We understand
that accessibility, value and cost containment are of paramount importance to
our customers, especially in a challenging economy. The S&P ratings confirm
that we are a strong company to do business with."
Standard & Poor's analysis noted that Delta Dental is extremely well capitalized,
which allows for both flexibility and growth. According to the report, Delta
Dental's membership is expected to increase in 2003. "We will continue efforts
to upgrade our customer service systems to ensure we are providing the best service
using leading-edge technology," said VanBrunt.
A nationwide poll conducted in 2002 found that demand for employer-sponsored
dental benefits remains high, despite overall concerns with the nation's healthcare
system. Studies have also shown that when employees maintain a higher level of
oral health, their employers experience cost and productivity benefits. Companies
who contract with Delta Dental to offer benefits are partnering with a financially
secure entity, and also offering their employees a quality, highly valued product.
The Thirteenth Annual Delta Dental Classic, which tool place in July at Fiddler's
Elbow Country Club, raised $55,000 for Special Olympics New Jersey (SONJ).
Since the Delta Dental Classic began in 1991, it has raised more than $410,000
for SONJ.
SONJ is dedicated to empowering individuals with mental retardation to become
physically fit, productive and respected members of society through sports
training and competition.
Contest winners include:
1st Place Low Gross (Ladies): Leslie Ann Skurla
1st Place Low Gross (Men): Darrin Joscelyn
1st Place Gross Team: Peter Louie, Fred Sterritt, Tom Morgenstern, Jim Schulz
Special thanks to all of our participants and sponsors.
The 14th annual Delta Dental Golf Classic will take place on June 23, 2004,
at Fiddler's Elbow Country Club in Bedminster, New Jersey. The golf classic
benefits Special Olympics New Jersey. More details will follow shortly.
On June 9, 2003, New Jersey Governor James McGreevey signed into law a comprehensive
reform package relating, among other things, to insurance fraud. The new law
is L. 2003, Chapter 89. It is accessible on the Web at http://www.njleg.state.nj.us/2002/Bills/PL03/89_.HTM.
The new law creates a new crime of "insurance fraud." In brief, any person
(including an insured or a licensed practitioner) who knowingly makes or causes
to make a false or misleading statement of material fact to an insurance company
(including medical and dental insurers, automobile insurers and professional
liability insurers as well as self-funded plans and the State Health Plan)
is guilty of "the crime of insurance fraud" if such statement is made in connection
with any of the following: a claim for payment or reimbursement; an application
for coverage; and any payment made or to be made in accordance with the terms
of an insurance policy. L.2003,
c.87, § 73 (codified at N.J.S.A. 17:33A-33).
The new law recites that it is intended to aggressively confront the problem
of insurance fraud by facilitating the detection, investigation and prosecution
of such fraud. L.2003, c.87, § 71(b).
Among the features of the bill are provisions that make it a second degree
crime: "if the person knowingly commits five or more acts of insurance fraud,
including acts of healthcare claims fraud, . . and if the aggregate value of
[the benefit] obtained or sought to be obtained is at least $1,000." L.2003,
c.89, § 73 (b) (codified at N.J.S.A. 17:33A-33(b).)
In determining whether the $1,000 threshold has been met, the amounts involved
in separate claims may be aggregated and the fraud need not have succeeded;
the amounts involved in attempted (unsuccessful) frauds are also includible.
This means that a covered person and/or practitioner who submits five claims
with knowingly misleading or false information material to the claim ("material" means
it's relevant -- an incorrect address which is irrelevant to the insurer's
action would not be material) of $200 each could be convicted of a second-degree
offense. Second-degree theft offenses in New Jersey are serious crimes; previously,
$75,000 was the minimum threshold to constitute a second-degree theft.
The clear message is that the State of New Jersey will be tough on persons
who engage in a pattern of insurance fraud, even if the claims are relatively
small. Although there must be five frauds to constitute a pattern, they can
all occur in one claim form, e.g. a claim for five separate services that deliberately
misrepresent the fees charged or services actually rendered. L.2003,
c.89, §
73(b) (codified at N.J.S.A. 17:33A-33(b).) The crime is a third-degree
offense if there are fewer than five claims or if the $1,000 threshold is not
met.
A similar provision has been on the books for healthcare claim fraud of licensees
for the last five years. The State of New Jersey has increasingly utilized
that law since its enactment. This law complements the healthcare claim fraud
law, increases the stakes for both practitioners and non-practitioners, and
expands it beyond health insurance.
The new law has also "upped the ante" against insurance fraud by creating
a system to provide financial rewards to those individuals who provide "information
leading to the arrest, prosecution, and conviction of persons or entities who
have committed healthcare claims fraud, insurance fraud or any other criminal
offense related to an insurance transaction." L.2003,
c.89, §
74(d) (codified at N.J.S.A. 17:33A-34(d).) Patients who suspect
their provider is overbilling, office staff who suspect upcoding, or former
employees who have pertinent information about similar misconduct can now receive
a reward of up to $25,000.
Now, more than ever, we encourage dentists and insureds to review claim preparation
and submission practices to assure that claims are accurate and that everyone
understands the stakes involved in submitting false information to dental or
medical carriers (as well as other carriers such as automobile insurers and
professional liability insurers).
This is not legal advice. We recommend that you confer with your legal counsel
for advice concerning this and other laws.
Nine out of ten benefits managers said their companies are "extremely satisfied" or "very
satisfied" with Delta Dental overall, and eight in ten felt their employees
are "extremely happy" or "very happy" with Delta Dental.
Those are among the findings of the 2003 Benefits Managers' Satisfaction Survey,
conducted by Brownstone Information Resources, Inc. for Delta Dental. The survey,
conducted annually, tracks benefits manager and member satisfaction levels
with Delta Dental. Brownstone conducted 250 telephone interviews with benefits
managers in New Jersey and Connecticut.
According to the survey:
- More than nine in ten benefits managers would recommend Delta Dental to
other administrators.
- Of the benefits managers who contacted Marketing Services in the past year,
nine in ten found Marketing Services to be "Extremely Helpful" or "Very Helpful."
More than eight in ten benefits managers said the following statements describe
Delta Dental "Extremely Well" or "Very Well":
- Claims are processed accurately
- Claims are processed quickly
- Employee/member can choose own dentist
- Monthly billing is accurate
- Billing issues are handled accurately, quickly by Billing Department
- Customer Service agents are courteous/pleasant/empathetic
- Eligibility changes, additions, deletions are processed accurately, quickly
The survey also tracks how much time benefits managers spend assisting employees
or members with claims or problems. More than nine in ten said they spend "about
the right amount of time" or "less time than expected" providing assistance.
Almost nine in ten benefits managers said they spend less than one hour per
week assisting employees/members with claims or problems.
The survey also looked at factors that influence a company's dental carrier
selection. Important factors identified by benefits managers included size
of dental network, plan flexibility, ease of administration, few complaints
from employees and cost. When asked what other factors were important, about
one in ten added reputation and past experience as important factors. While
only about one in four managers feels that "Non-profit status" is an "Extremely
Important" or "Very Important" factor in selecting Delta Dental, about half
feel that contributions of the Delta Dental Foundation are important.
Delta Dental Plan of New Jersey Foundation recently sponsored a two-part program
called "Oral Health: The Quiet Crisis" presented on Caucus New Jersey with
Steve Adubato.
The program included a discussion of the link between oral health and one's
overall health, as well as the issue of access to dental care.
If you would like to receive a videotape of the program, please e-mail your
request to smile@deltadentalnj.com.
Delta Dental will be participating in the following upcoming conventions:
New Jersey School Board Association
October 22-24, 2003
Atlantic City Convention Center
Atlantic City, New Jersey
New Jersey League of Municipalities
November 17-20, 2003
Atlantic City Convention Center
Atlantic City, New Jersey
Be sure to stop by our booth!
Benefits managers often need to keep a paper trail of eligibility submissions.
Our online eligibility submissions system makes it extremely easy for them
to create a paper trail of the eligibility changes they submit online.
The "View Log" feature enables users to view and print out all the changes
made in an online session to verify accuracy. The submission log not only lists
the subscriber's name and date of each change, but also identifies which fields
were changed, for easier verification. Our online eligibility submission system
is password-protected and safeguarded against unauthorized access.
To get started using Delta Dental's online eligibility submission system,
benefits managers should contact Premium Billing at (973) 285-4144 anytime
Monday through Friday from 8 a.m. to 4:30 p.m. to request their password. Then,
go to www.deltadentalnj.com, click "Employers," and sign into the Administrator's
Logon area.
Delta Dental's online Benefits Connection is the fastest, easiest way for
employees to obtain information about their dental benefits. To help benefits
managers get the word out to employees, Delta Dental developed a Benefits Connection
communication package. The package features articles, a how-to guide, and more.
To request the package, benefits managers should send an e-mail to dbelle@deltadentalnj.com.
Information will be sent to them via e-mail.
Dr. Scott Navarro, Vice President of Professional Services
and Dental Director for Delta Dental, recently received the
Dr. Israel (Sonnie) Shulman Award for Meritorious Service
from the American Association of Dental Consultants (AADC).
The AADC is comprised almost entirely of dentists who serve
as consultants to dental insurance carriers. The primary
purpose of the organization is to educate and inform its
nearly 400 national and international members.
The award, which has only been granted three times in the
past, recognizes AADC members for outstanding contributions
to the organization, and for exhibiting behavior of being
a mentor and guiding light. Recipients are nominated, with
the AADC board of directors making the final decision.
"Dr. Navarro, as past president of AADC, as chair and developer
of the Certification Program, for his insight and authorship
of position papers, and for being the dental consultant's
consultant, certainly qualifies for this award," says AADC
President Dr. Ed Schooley, dental director of Delta Dental
Plan of Iowa.
"Dr. Navarro is one of a kind," Dr. Schooley adds. "Having
worked with him on a number of projects and teams, he seems
to have inexhaustible energy and commitment to doing a best-in-class
job in anything he touches. Dr. Navarro has often independently
championed efforts within AADC and is responsible for where
it is today. He has left his mark! I am pleased that he has
been recognized in this manner."
Dr. Navarro recently celebrated his sixth anniversary at
Delta Dental. His primary responsibilities include dentist
network development and contracting, professional claims
review, dental policy, and professional relations. He also
serves as a member of the Delta Dental Plans Association
Dental Policy Committee.
Walter VanBrunt, president and CEO of Delta Dental Plan
of New Jersey, was re-elected chairman of the board of directors
of the Delta Dental Plans Association (DDPA) during the organization's
annual meeting in June.
The Delta Dental Plan system is a national network of independently
operated, not-for-profit dental service corporations specializing
in providing dental benefits for employee groups throughout
the country.
VanBrunt joined Delta Dental Plan of New Jersey as senior
vice president in January 1993. He became executive vice
president in November 1993, and president of Flagship Dental
Plans. He became president and CEO of Delta Dental Plan of
New Jersey in January 1998. He also serves on the Board of
Trustees for the Delta Dental Plan of New Jersey Foundation.
He is also a member of the Board of Advisors for the UMDNJ-New
Jersey Dental School.
A section of our Web site has been enhanced to make it easier
for brokers, benefits administrators, subscribers and participating
dentists to find information about DeltaCare. The section
answers to subscribers' frequently asked questions, lists
of key contacts for benefits administrators, and much more.
To access information on DeltaCare, go to www.deltadentalnj.com
and click
"Flagship" on the navigation bar on left side of
the screen.
DeltaCare is a dental HMO- type program, underwritten and
administered by Flagship Dental Plans, a wholly owned subsidiary
of Delta Dental Plan of New Jersey, Inc.
The Health Insurance Association of America (HIAA) has recently
expanded its education program to make it even more accessible
to busy professionals by offering live training workshops
and online testing. And, with more than 20,000 students a
year enrolled in its self-study courses, HIAA's programs
have proven to provide practical guidance to help insurance
and healthcare employees gain a better understanding of the
standards and regulations that impact the health insurance
industry.
For more information on HIAA's course offerings, visit
the Insurance Education Web site at www.insuranceeducation.org.
The newest face in Delta Dental's south Jersey office is
Pam Haddock, Marketing Department secretary.
Before joining Delta Dental in February 2003, Pam worked
at an insurance agency near her home in Little Egg Harbor.
She received her individual producer license for health,
property and casualty insurance in 2001.
Pam anchors the three-person Delta Dental office in Hammonton.
Her duties include making sure that brokers' requests are
handled even when Account Executive Sal Putiri and Service
Coordinator Kris Gallagher are out of the office. Doing so
often means working with people in various departments at
Delta Dental's headquarters in Parsippany.
"I want to ensure that brokers receive the information they
need, when they need it," says Pam. "Even after I hand off
requests to others in Delta Dental, I still stay in touch
with the brokers to keep them up to date. This way brokers
know what to expect and when information should arrive."
Depending on the individual broker's needs, Pam communicates
with brokers by phone, fax, e-mail and regular mail. Pam
will continue to track the progress of each broker's request
until it is fulfilled. "I want to make sure that brokers
find it convenient to do business with Delta Dental," she
says.
|
