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Articles
Benefits Connection Launches; New Online
Service Gives Dentists Access to Patients' Dental
Benefits Information
What You Should Know About HIPAA
A Message from Delta Dental Plan of New Jersey
President and CEO Walter VanBrunt
Mobile Dental Service Takes to the Road in
Paterson with Foundation Support
Wireless Phone Discounts Latest In-Net Program
for Participating Dentists
SAFECO to Discontinue Preferred Dental Professional
Liability Insurance Program; Herbert L. Jamison & Co.,
L.L.C., SAFECO's Administrator, Developing an Alternative
Delta Dental Introduces New, Easy-to-Read
Explanation of Benefits Statements
First "Delta Dental Day" Gets Great
Reviews from Dentists and Their Office Staff
Benefits Connection Launches;
New Online Service Gives Dentists Access to Patients'
Dental Benefits Information
Delta Dental Plan of New Jersey now offers a new
online service that makes it possible for participating
and non-participating dentists to obtain instant,
detailed information about their patients' dental
benefits.
Using Delta Dental's Benefits Connection, patients
and their dentists can easily determine what services
are covered, the percentages that Delta Dental will
cover, whether there are deductibles or waiting periods,
and more. (Note: Due to different family enrollment
plans, eligible family members may not display if
a claim has not yet been processed for them.) With
Delta Dental's Benefits Connection, dental offices
no longer need to call Delta Dental's Customer Service
Department to verify patient eligibility and benefits.
It's all at your fingertips. In less than 30 seconds,
using a standard browser such as Internet Explorer
or Netscape and an Internet connection, you can find
the answer online through Benefits Connection.
Delta Dental's Benefits Connection is available
24 hours a day, seven days a week, 365 days a year.
While Benefits Connection makes it easy for patients
and dentists to retrieve information, it also protects
patient privacy. Benefits information can be accessed
on a secured area of the site only by those who are
authorized to receive it - patients and their dentists.
The system automatically verifies and authenticates
the identity of users to protect patient privacy.
Dentists can access Delta Dental's Benefits Connection
by logging on to www.deltadentalnj.com and clicking
on Benefits Connection under the Dentists section.
What You Should Know About HIPAA
One of the purposes of the Health Insurance Portability
and Accountability Act (HIPAA), which was passed
in 1996, is to encourage the efficient use of electronic
data interchange in the health care system. The HIPAA
subtitle standardizes specific electronic transactions
used in the health care arena by requiring that certain
formats and specified code sets be used.
Who must comply?
All health plans and health care clearinghouses and
those health care providers who transmit certain
health information in electronic form are considered "covered
entities"
and must comply with these new requirements of the
EDI Rule. Dentists who transmit health information
in electronic form in connection with a "transaction" defined
under the EDI Rule (either directly or by means of
a clearinghouse) are considered "covered entities" under
HIPAA. (Note: A "transaction," under the
EDI Rule, is
"an exchange of information between two parties
to carry out financial and administrative activities
related to health care." When conducted electronically,
a transaction involves sending information to the
other party's computer via the Internet, a private
line or a private electronic network.)
If a dentist conducts a particular business transaction
on paper, that transaction is not subject to the
EDI Rule. In this regard, a dentist can choose to
submit paper claims to one health plan and electronic
claims to another. Or, a dentist may submit a paper
claim for one patient to a health plan, but an electronic
claim for another patient to the same health plan.
Fax imaging and voice response transmissions are
not subject to the EDI Rule (but are subject to HIPAA
privacy regulations if the provider engages in any
standard transactions).
What are some typical transactions under the
EDI Rule?
Many transactions are regulated by the EDI Rule.
The ones that will be used frequently by dentists
will most likely be health care claims, coordination
of benefits, health care claim status, referral certification
and authorization, health plan eligibility and health
care payment and remittance advice.
Are there other HIPAA regulations besides the
EDI Rule?
The EDI Rule is just one of many that will affect
your practice. Under HIPAA, those dentists who are
covered entities will also need to address security
and privacy concerns with respect to health information.
These are addressed under other HIPAA rules.
Do I now have to conduct all transactions electronically?
Dentists and dental office staff are not required
under HIPAA to conduct business transactions electronically.
Please note, unless otherwise prohibited under
law, a health plan may require a network dentist,
pursuant to its contract with that dentist, to
use electronic transactions. Delta Dental Plan
of New Jersey, however, does not require its participating
dentists to conduct transactions electronically.
Are there specific requirements for electronic
transactions?
If a dentist does submit transactions electronically,
and the transaction is one for which the EDI Rule
has established requirements, then the dentist must
use the standard format as well as any required code
set. This is referred to as a "Standard Transaction." The
only exceptions to using the standard format and
required code set are when the dentist: (i) transmits
information to a health plan's computer through direct
data entry such as dumb terminals or Web browsers
(although the dentist still must observe data content
and condition requirements), or (ii) uses a clearinghouse
for purposes of conducting the transaction - as the
clearinghouse (and its subcontractors) must comply
with the EDI Rule.
When conducting an electronic transaction covered
by the EDI Rule, dentists are required to use the
Current Dental Terminology, Third Edition ("CDT-3").
Dentists can obtain a copy of the CDT-3 code by contacting
the American Dental Association. The ADA may charge
for this service.
What if I submit electronic claims through a
clearinghouse?
Clearinghouses are also considered covered entities
under HIPAA. For those dentists who send electronic
claims through a clearinghouse, the transactions
can be in non-standard formats as long as the clearinghouse
converts it to the standard before sending it to
a health plan.
When does the EDI Rule take effect?
Dentists planning to conduct electronic transactions
covered by the EDI Rule must comply with the EDI
Rule by the designated deadline of October 16,
2002. Health plans, however, may require compliance
ahead of schedule. State laws may also require
compliance ahead of this schedule.
What should dental offices start doing now to
prepare?
Dentists who conduct transactions electronically
(either directly or by means of a clearinghouse)
should start to review their internal operations
immediately if they haven't already done so. This
should include a review of their relationships with
software companies and clearinghouses to ensure compliance
with the EDI Rule.
Delta Dental will be making changes in our Agreements
with dentists to comply with HIPAA. Dentists will
also need to amend contracts that they have in place
with their business partners (all persons who provide
services to covered entities involving their access
to and use of individual patient information such
as billing services, attorneys and accountants, photocopying
services, labs, etc.).
The trading partner agreement between a HIPAA "covered
entity" and a business associate cannot do any
of the following:
- Change the definition, data condition or use
of a data element or segment in a standard;
- Add any data element or segments to the maximum
defined data set;
- Use any code or data elements that are either
marked
"not used" in the standard's implementation
specification or are not in the standard's implementation
specification(s);
- Change the meaning or intent of the standard's
implementation specification(s).
Covered entities must also comply with business
associate contracting requirements set forth under
HIPAA's recently finalized privacy rule and soon-to-be
finalized security rule.
Will the EDI Rule affect claims reimbursement?
The EDI Rule does not affect a health plan's claims
reimbursement policies. Delta Dental Plans will
continue to apply the Delta Dental Processing Policies
using the CDT-3 codes, thereby preserving the "Delta
Difference."
Where can I get more information?
We recommend that dentists review the EDI Rule, as
well as the Implementation Guides referred to in
the EDI Rule. The Implementation Guides provide
operational guidance and instruction and are available
from Washington Publishing Company, PMB 161, 5284
Randolph Road, Rockville, MD 20852-2116, phone
301-949-9740, fax 301-949-9742, www.wpc-edi.com.
For additional information on HIPAA, you may also
visit www.wedi.org,
the site for the Workgroup for Electronic Data
Interchange. This information is for instructional
and educational purposes only. It does not constitute
legal advice. Recipients are urged to contact their
legal counsel for advice with respect to the interpretation
of the HIPAA EDI Rule and its applicability to
the recipient and the facts and circumstances of
the situation at hand.
A Message from Delta Dental Plan
of New Jersey President and CEO Walter VanBrunt
Our thoughts and prayers go out to those who have
suffered a loss in the tragic and senseless attack
on America September 11. We wish to extend our deepest
gratitude to all who have bravely dedicated themselves
to the rescue and recovery efforts.
As a company and as individuals, we are doing everything
we can to help. Two employees - Justin Lahullier
of Flagship and Bob Allen of Customer Service - were
directly involved in rescue-related activities at
the World Trade Center. Many others donated blood
at our on-site blood drive, and contributed generously
to the American Red Cross and the Twin Towers Fund.
Delta Dental is matching their monetary contributions
through a donation to the Red Cross.
None of us will ever forget what happened on September
11. But as our nation courageously carries on, we
at Delta Dental will strive to do the same.
Mobile Dental Service Takes to
the Road in Paterson with Foundation Support
For far too many people, dental care is not affordable
or accessible. But thanks to a new program developed
by St. Joseph's Regional Hospital & Medical Center,
thousands of the homeless and working poor will now
receive the care they need at sites throughout Paterson,
NJ, and the surrounding areas.
Delta Dental's Foundation provided major funding
for St. Joseph's Dental Outreach Program, which launched
in October. Each day of the week, the Dental Outreach
Program's mobile dental van travels to a different
site, include homeless shelters, churches and mosques.
The van carries everything necessary to set up a
temporary, but fully functional, dental office in
any room. The portable equipment includes a dental
chair, lights, cuspidor attachment, setup for handpieces
and other equipment, and an x-ray machine.
"Anything that can be done in a dental office
we are able to do wherever we go," says Hillel
Ephros, DMD, MD, Chairman of the Department of Dentistry
at St. Joseph's. The program is staffed full-time
with a dentist, dental hygienist, dental assistant
and clerical person.
Dr. Ephros and others at St. Joseph's had worked
for several years to develop a mobile dental program
that would reach the underserved. They based part
of their idea on several for-profit mobile-dental
operations, which provide care to homebound patients
and those in nursing homes. "We wanted to provide
access to those with limited or no access to care," says
Dr. Ephros. "We were able to identify many sites
in this area where there was an underserved population
whose needs could be met."
In addition to the Dental Outreach Program,
St. Joseph's offers several other programs
that provide free or low-cost care to those
in the community who need it, including free
routine dental care to every student in the
Paterson School District. Dr. Ephros credits
Delta Dental's contribution with enabling the
hospital to expand its outreach services.
"We saw a need to take care of people
who are unable to pay for dental services," says
Dr. Ephros. "Delta Dental's generous gift
made it possible to get this program on the
road."
The Delta Dental Plan of New Jersey
Foundation supports a number of programs
that bring dental services to the indigent
and underserved populations throughout
New Jersey. The work of the Foundation
is one way that Delta Dental Plan of
New Jersey achieves its mission: To promote
oral health to the greatest number of
people by providing accessible dental
benefit programs of the highest quality,
service, and value.
Wireless Phone Discounts Latest
In-Net Program for Participating Dentists
Delta Dental and Sprint PCS have announced a program
that offers participating New Jersey and Connecticut
dentists a 5% discount on wireless telephone rate
plans.
Wireless America, which administers the program,
will also provide participating dentists a wide selection
of phones, as well as discounts of up to 50% on wireless
accessories. In addition, participating dentists
will receive a free car adapter AND either a leather
case or hands-free headset with each new activation.
Delta Dental will also designate $20 to Special
Olympics New Jersey for each new activation by a
participating dentist.
For more information, visit the Wireless America
website at www.wirelessamerica.com/deltanj. To enroll,
contact Wireless America at 888-655-4727, ext. 123,
or via e-mail at tonyg@wirelessamerica.com.
SAFECO to Discontinue Preferred
Dental Professional Liability Insurance Program;
Herbert L. Jamison
& Co., L.L.C., SAFECO's Administrator, Developing
an Alternative
SAFECO Insurance decided this past summer to cease
writing dental professional liability insurance as
of January 28, 2002.
The reason for this position, as relayed to us by
the insurance brokerage firm Herbert L. Jamison & Co.,
L.L.C., relates to SAFECO's corporate decision to
focus on its more traditional lines of commercial
insurance business, which have been geared to the
small- and medium-sized business insurance markets.
As part of this strategy, SAFECO is withdrawing from
all professional liability insurance lines, including
dental professional liability insurance. (Jamison
acts as the SAFECO Preferred Dental Professional
Liability Insurance Program Administrator in several
states, including New Jersey and Connecticut.)
Jamison advises that the SAFECO Dental Professional
Liability Program, which had been in operation in
various parts of the United States for approximately
20 years, has been profitable. SAFECO's decision
is not based on concern about underwriting dental
professional liability insurance. Rather, it is essentially
a business decision centered on issues relating to
the best way to focus and allocate resources to its
more traditional business.
Jamison has advised us that there are a number of
existing professional liability insurance programs
in place to which dentists can look for protection.
Jamison reports that it is, in fact, diligently working
on developing an alternative program and will make
dentists aware of such as soon as the new program
is in place and operational.
Jamison advises that SAFECO policies currently in
force will not be canceled and will run their full
12-month terms as long as the premiums are timely
paid. As to policies with renewal dates before January
28, 2002, SAFECO will be offering full 12- month
renewal terms; but at the conclusion of those 12-month
renewal terms, further renewals will not be offered
by SAFECO. As to policies with renewal dates of January
28, 2002 and later, SAFECO will not be offering renewal
terms and these dentists will be notified of the
non-renewal position of SAFECO well in advance of
their renewal dates. Either Jamison or local brokers
will be able to assist those dentists in replacing
that coverage.
Jamison advises that it can offer new policies to
qualified dentists under the SAFECO Program as long
as the inception dates of those policies are before
January 28, 2002. In those cases, the SAFECO policies
would run for full one-year terms but would not be
renewed by SAFECO upon their expiration. At that
point, Jamison or local brokers can assist dentists
in seeking replacement of that coverage.
As reported by Jamison, SAFECO has made it clear
that it intends to make an orderly withdrawal from
the professional liability business. The approximate
six-month withdrawal timeframe plus the commitment
not to cancel policies before they expire are designed
to effectuate a smooth and amicable transition.
Louis F. Barbaro, Vice President of Herbert L. Jamison
& Co., L.L.C., reports that as soon as its alternative
program is in place, Jamison will begin offering
it to its SAFECO-insured dentists and other qualified
dentists as well. Barbaro advises that Jamison regrets
SAFECO's decision but adds that Jamison is making
every effort to develop a viable alternative for
dentists so that they can maintain broad protection
at favorable pricing from a committed and expert
professional liability insurer. Barbaro advises that
under the alternative program Jamison is seeking
to develop, prior acts coverage will be afforded
to qualified dentists so that they would not have
to be concerned about buying a "Tail" or
Extended Reporting Period Endorsement under their
previous coverage.
Delta Dental Introduces New,
Easy-to-Read Explanation of Benefits Statements
Delta Dental's notification of benefits statement
now features a clean, new look and a new name: Explanation
of Benefits. The redesigned statement includes the
same information as before, but is presented in a
more readable, user-friendly format. In addition
to receiving an Explanation of Benefits statement
for each patient, participating dentists also receive
a Summary Sheet, which consolidates information from
each Explanation of Benefits into a single document.
The Summary Sheet lists each patient's name, claim
number, ID number and Delta Dental payment. The claims
check is attached to the bottom of the first page
of the Summary Sheet. A detailed description of the
new statement will accompany this new Explanation
of Benefits.
First "Delta Dental Day" Gets
Great Reviews from Dentists and Their Office Staff
Nearly 60 dentists and dental-office-staff members
attended the first-ever "Delta Dental Day" in
Hasbrouck Heights, NJ, on September 26. The half-day
informational seminar featured sessions on such subjects
as Delta Dental's programs and how they work, how
to submit claims to expedite processing and payment,
electronic claims, the "latest and greatest" technologies
available at Delta Dental, and fraud.
Two more Delta Dental Days took place on October
17 and October 24. Nearly 120 dentists and dental
staff members attended these sessions in Princeton
and Morristown, NJ. Delta Dental subject matter experts
led the program and the question and answer session
afterward.
Beatrice Buccos, manager, network development, explained
how Delta's Advantage, DeltaPremier and DeltaPreferred
Option programs work and what is required for dentists
to participate with each. Peggy Marvin, director,
Claims, covered CDT-3 coding, helpful hints to prevent
claim processing delays, and how (and when) to submit
x-rays. Beth DeCapio, dental network coordinator,
provided an overview of the advantages of electronic
claims, how dental offices can begin submitting electronic
claims, and what Delta Dental does to help expedite
electronic claims even further. Mark Franklin, administrator,
Claims Verification, explained what constitutes unacceptable
billing practices, how Delta Dental detects fraud,
and the consequences of fraud. Michelle Mulhern,
director, Customer Service, talked about what is
new and improved at Delta Dental, including the recently
launched Benefits Connection, which enables dental
offices to verify patient eligibility online.
Those attending Delta Dental Day received a copy
of each speaker's PowerPoint slides, a list of DeltaUSA
addresses nationwide, Delta Dental program descriptions
and other materials about Delta Dental. The overall
seminar received
"excellent" or "above average" evaluations
from nearly everyone who attended. Some comments
included:
- "I would like to thank Delta Dental for
making things as easy as possible for the office.
I could only wish more insurance companies would
do the same."
- "This was a great presentation."
- "It was well organized and informative."
- "I appreciate the care Delta Dental shows
toward dental professionals."
- "The seminar was excellent."
- "Very well organized presentations."
- "Very informative. Thank you."
- "Excellent seminar. Everything was understandable.
Again, excellent!"
Delta Dental Day seminars will also take place in
Connecticut in spring 2002.
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