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Articles
Delta Dental Expands Coverage for Localized
Delivery of Chemotherapeutic Agents
Need Claim Forms?
DeltaPreferred Option Point of Service Product
Periodontal Maintenance Procedure (04910)
Processing Policy
NJ Credentialing Survey Now Due
New Web Feature: Online Directions to Dental
Offices
New Code Implementation
New X-ray Envelopes for Electronic Claim Submitters
Delta Dental Plan of New Jersey Participating
Dentist Handbook
DeCapio Named New EDI Coordinator
Delta Dental Grew 20% in 1999, Says Annual
Report
Delta Dental Expands Coverage
for Localized Delivery of Chemotherapeutic Agents
After careful evaluation and study, Delta Dental
Plan of New Jersey, Inc. is pleased to announce that
it will expand benefits for codes 04381 and 04382
to include Atridox and Perio Chip, as well as Actisite.
Dentists should report the procedures using the following
codes:
- 04381-Localized delivery of chemotherapeutic
agents via a controlled release vehicle into diseased
crevicular tissue-first site in a quadrant
- 04382-Localized delivery of chemotherapeutic
agents via a controlled release vehicle into diseased
crevicular tissue-two or more sites in a quadrant
A site is defined as a contiguous defect, which
may involve up to two adjacent diseased teeth, which
may cross the midline.
Dentists must report the type of chemotherapeutic
agent used in the description column on the same
line as the procedure code. The reimbursement will
vary based on the chemotherapeutic agent used. X-rays
are required for claim review.
Benefits will be allowed in lieu of benefits for
traditional surgical procedures under the following
conditions:
- Patient must have had scaling and root planing
(04341) and/or a periodontal maintenance procedure
(04910) six weeks to six months prior to the treatment.
- Retreatment of an area is not benefited within
24 months from original treatment.
- Traditional surgery is not benefited within 12
months of original treatment.
Delta Dental will review utilization patterns every
six months to determine if this benefit will continue
to be considered payable. As always, we recommend
submitting pretreatment estimates prior to beginning
this type of treatment.
Need Claim Forms?
Did you know that you can e-mail us your request
to have a supply of claim forms mailed to you? You
can also download a copy of the claim form from your
computer. To e-mail a request or download forms,
visit our website at www.deltadentalnj.com.
DeltaPreferred Option Point of
Service Product
Now Being Offered to Connecticut Groups
In January, Delta Dental Plan of New Jersey responded
to requests from the marketplace and began making
our DeltaPreferred Option Point of Service (PPOS)
available to some Connecticut groups.
This plan design has been available in New Jersey
since 1999.
When a group selects this plan design, benefits
for their members are automatically determined by
the program(s) in which the dentist participates
with Delta Dental. The program does not require a
specific enrollment choice by the member. Benefits
for members receiving services from dentists participating
with DeltaPreferred Option will be based on the group's DeltaPreferred+Option coverage.
Benefits for members receiving services from dentists
not participating with DeltaPreferred Option will
be based on the group's out-of-network coverage,
and in some cases will be determined as though the
member has our usual DeltaPremier coverage.
Effective January 1, 2000, Pitney Bowes (Group #5855)
began offering the DeltaPreferred Option Point of
Service to all of its 20,000-plus employees, most
of whom are in Connecticut.
Delta Dental will be encouraging groups to offer
enhanced benefits for members receiving services
from DeltaPreferred Option Participating Dentists.
To verify coverage and the fee allowances of a particular
PPOS group, please contact our Customer Service Department
at (800) 452-9310. If you have any questions concerning
participation in the DeltaPreferred Option product,
please contact Desiree Fusco at (860) 859-1767 or
Beatrice Buccos at (973) 285-4201.
Periodontal Maintenance Procedure
(04910) Processing Policy
Beginning September 1, 2000, in conjunction with
the implementation of the CDT-3 codes, Delta Dental
Plan of New Jersey will implement the policy identified
in your Dentist Handbook (page 9-17) regarding 04910-Periodontal
Maintenance Procedures. This policy recognizes that
an evaluation is included as part of the 04910. Therefore,
beginning September 1, the fee for the evaluation
as a separate procedure will be disallowed and will
not be collectable from the patient by a participating
dentist. Dentists may want to take this into account
when filing their fees for this procedure.
NJ Credentialing Survey Now Due
Have you completed your Delta Dental credentialing
questionnaire yet?
Delta Dental requires all Participating Dentists
in New Jersey to complete this survey, which asks
for general office information and specific information
about your dental license, specialty certifications,
insurance coverage and infection control policies.
It also requires copies of documents such as your
dental license.
Information about our credentialing process was
mailed in February. If you did not receive a credentialing
packet, please contact our Credentialing Department
at (888) 203-6993. For assistance completing the
credentialing paperwork, please contact our dental
network coordinators at (888) 396-6641.
Please note: If you participate in DeltaPreferred
Option or Delta's Advantage Program, you should have
received the credentialing packet for those programs
and not a separate DeltaPremier packet.
You need to complete only one credentialing form
for the applicable program. Failure to complete these
documents will result in termination of your participation
status.
New Web Feature: Online Directions
to Dental Offices
Patients in search of a participating dentist near
them can throw away their maps and instead log onto
Delta Dental's website.
The website not only helps patients identify participating
dentists who practice near their home or workplace,
but can now tell them how to get there. The site
now offers free instant maps and customized directions
to participating dental offices.
To check out this service, go to www.deltadentalnj.com
and follow the prompts. Please note that maps and
directions are accessible only if you indicate in
Step 3 that you want to search the directory to find
a convenient dentist. The map and direction option
is not available if you indicate you want to look
up a particular dentist.
New Code Implementation
Effective July 1, 2000, dentists will be able to
submit all new CDT-3 codes to Delta Dental Plan of
New Jersey for direct claims processing. Acceptance
of these codes does not necessarily mean that they
will be benefited procedures. Chapter 9 of the Dentist
Handbook is being revised to reflect the new codes,
as well as Delta Dental's processing policies regarding
these codes. See page 4 in this issue of Dental News
for an abbreviated fee filing form, which you may
fax to Delta Dental at (973) 285-4140, or mail to
Delta Dental, Professional Relations, P.O. Box 222,
Parsippany, NJ 07054. You may direct questions regarding
filing the form to our Professional Relations Department
at (973) 285-4163 or (973) 285-4064.
New X-ray Envelopes for Electronic
Claim Submitters
With a growing number of dental offices converting
to paperless claim submission, we continuously search
for ways to improve our processes. Our latest improvement
is the introduction of special x-ray envelopes for
our electronic claim submitters. These canary yellow
envelopes will assist us in identifying x-rays submitted
via electronic claims so we can give them priority
handling.
Electronic claim submitters are encouraged to use
these special pre-addressed #10 size envelopes when
sending bitewing and/or periapical x-rays. Please
place the x-ray in a coin envelope and write the
Delta Dental claim number found on your electronic
claim status report on the coin envelope, along with
the dentist's name, patient's name, and Social Security
number. For information on the electronic claim status
report, please call your dental practice management
software vendor or claim clearinghouse.
To order your supply of envelopes, please call Beth
DeCapio, EDI Coordinator, at (973) 285-4035, or e-mail
her at bdecapio@deltadentalnj.com.
Delta Dental Plan of New Jersey
Participating Dentist Handbook
In April 1999, Delta Dental Plan of New Jersey sent
to each participating dentist the Delta Dental Plan
of New Jersey Participating Dentist Handbook. This
handbook was designed to assist you in better understanding
dental programs, benefits, policies and procedures.
We would like to remind you to refer to Chapters
8 and 9 of this handbook when you need to review
processing policies for both DeltaUSA and Delta Dental
Plan of New Jersey enrollees. Chapters 15 and 16
refer to PPO Dentists Rules and Regulations applicable
to DeltaPreferred Option and Delta's Advantage Program,
respectively. If you have any questions about the
handbook, please contact a Delta Dental dental network
coordinator at (888) 396-6641.
DeCapio Named New EDI Coordinator
We are pleased to announce that Beth DeCapio is
Delta Dental's new EDI Coordinator. Beth brings several
years of customer service and dental claims processing
experience to this position.
"My goal is to continue educating dental offices
about the benefits of Electronic Claim Submission,
or ECS," says Beth. "ECS delivers faster turnaround
times on claims. It's more cost-effective because
it reduces the time and money dental offices spend
on submitting claims. With ECS, for instance, Delta
Dental has dedicated staff to process these claims,
which improves turnaround times."
If you would like to find out more about how
ECS can benefit your practice, please contact
Beth DeCapio at (973) 285-4035. She will be
happy to schedule an appointment that is convenient
for your office.
Delta Dental Grew 20% in 1999,
Says Annual Report
Delta Dental Plan of New Jersey achieved its biggest
growth increase ever in 1999. New sales topped $31
million, our total business increased to almost $300
million, and we added more than 240 new groups in
1999.
These were just some of the achievements highlighted
in our recently published 1999 Annual Report.
Other accomplishments include:
- Retaining our role as New Jersey's leading and
largest dental benefits carrier, providing coverage
to more than 1.3 million people through contracts
with employers in New Jersey and Connecticut.
- Maintaining a customer-retention rate of 95 percent-a
rate we have consistently maintained for the past
12 years.
- Processing more than 2 million claims-16% more
than in 1998.
- Answering more than a half million calls to Customer
Service-and answering 75% of all inquiries effectively
and accurately in under one minute.
- Providing one of the nation's most extensive
dental-provider networks, with three out of four
dentists nationwide participating.
- Meeting all of our Y2K compliance goals.
- Replacing mainframe hardware and rebuilding our
Image system to make service faster and more efficient.
- Upgrading technology platforms, which will enable
Delta Dental to soon put in place a comprehensive
Customer Service/Internet strategy.
To request a copy of the 1999 Annual Report, send
an e-mail to administration@deltadentalnj.com or
call Kelly White at (973) 285-4020.
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