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Articles
2004 Marks 35 Years for Delta Dental
Foundation Gives Back to NJ Communities
Delta Dental Employees Help Children
Affected by AIDS
Golf Classic Reminder
Subscribers Give DeltaCare Dental HMO High Ratings
in Survey
Tech-Niques: How Anti-Virus Software, Firewalls
Protect Your System
HIPAA's Impact on Delta Dental's Claim Verification
Activities
Delta Dental Promotes Electronic Attachments with These Benefits
COB FAQs
Benefits Connection Tip
2004 Marks 35 Years for Delta
Dental
This year Delta Dental Plan of New Jersey celebrates
our anniversary using the theme "35 Years Dedicated
to Healthy Smiles." We began providing quality dental
benefit programs in 1969.
Delta Dental is committed to providing excellent
service to you and excellent value for your patients.
We continue to be dedicated to serving you and your
patients. Thank you for helping us to reach this
milestone.
Foundation Gives Back to NJ Communities
There's more to Delta Dental Plan of New Jersey
than providing quality dental benefits programs.
Our charitable arm, the Delta Dental Plan of New
Jersey Foundation, Inc., reaches out to communities
and helps those without dental insurance get dental
treatment, as well as funds scholarship programs
for dental assisting and dental hygiene programs
at schools throughout New Jersey.
In 1986, the Delta Dental Endowment Association of
New Jersey was organized to help promote educational
projects devoted to enhance dental health, and support
research programs that increased public awareness
of the importance of dental health. In 2000, the
Endowment Association changed its name to the Delta
Dental Plan of New Jersey Foundation, Inc. The Foundation
continues to provide financial support to programs
that promote and provide dental care.
The Foundation's 14-member board meets four times
a year to review grant requests and make awards.
The board also follows up on all grants by requiring
each funded organization or school to submit outcomes
reports giving a breakdown of the results of their
programs. Organizations and educational institutions
apply each year for financial support. The Foundation
must determine which ones are most in line with the
Foundation's goals.
Delta Dental's Foundation donates money to many community
clinics and organizations to help the underserved
(individuals who do not have dental insurance or
are unable to access dental treatment) obtain dental
care. Some of those facilities are Dover Community
Clinic, Henry J. Austin Health Clinic in Trenton,
Newark Beth Israel Medical Center, Northwest New
Jersey Dental Coalition (Newton Memorial Hospital),
Paterson Public Schools Dental Clinic, and Virtua-West
Jersey Hospital in Camden.
The Foundation also funds organizations that provide
dental treatment to children and adults with severe
disabilities. Some of those organizations are:
- Kessler Memorial Hospital (treat developmentally
disabled)
- Kimball Medical Center (offer emergency dental
care to underserved, mentally handicapped people
and children)
- Matheny School and Hospital (provide dental care
for children and adults with developmental impairments
such as cerebral palsy, spina bifida and muscular
dystrophy)
- NJ Foundation of Dentistry for Persons with Disabilities
(provide dental care for elderly and mentally/physically
handicapped-with disorders such as lymphoma and
multiple sclerosis-for patients of all ages who
have severely neglected dental problems)
Thanks to the support of the Foundation, dental
assisting and dental hygiene scholarships have been
established at colleges throughout the state. Some
of the schools include: Bergen Community College,
Camden County College, Mercer County Technical School,
Middlesex County College, and the University of Medicine
and Dentistry of New Jersey (UMDNJ). Due to the shortage
of dental professionals, the Foundation also provides
a certain number of students pursuing a career in
dental care financial support each year.
For the past 17 years, the Delta Dental Plan of New
Jersey Foundation, Inc. has funded dental scholarship
programs and supported community clinics and organizations
to help ensure that greater access to dental care
is achievable. The Foundation continues to promote
the importance of dental health through all the programs
it funds each year.
Delta Dental Employees Help Children
Affected by AIDS
Employees donated gifts for more than 100 children
whose families are affected by AIDS. Angel Connection,
a nonprofit organization in Morris County, New
Jersey distributed the presents.
The two infant girls slept peacefully side by side
in a stroller while adults in the kitchen chatted
about upcoming holiday parties and gifts still left
to wrap. But the conversation soon switched to a
more serious topic: HIV and AIDS, and how they affect
thousands of area children, including the two napping
infants. Born prematurely last summer to HIV-infected
mothers in New Jersey, they, too, carry the disease.
But Chaplain Carol Bamesberger, director of the nonprofit
group Angel Connection, and her cadre of volunteers
refuse to focus on the tragedy of AIDS, and instead
strive to improve the lives of children and families
who live daily with the disease.
For the past 11 years, Angel Connection has worked
with businesses throughout New Jersey on holiday
toy drives. Employees at organizations including
Delta Dental buy gifts for children whose families
are affected by AIDS.
Unlike most toy drives, Angel Connection does not
present the gifts directly to children. Instead,
gifts are delivered to parents and guardians so they
have something to give to their children. Many parents
are so weakened and impoverished by illness that
this is the only way they can give their children
anything.
For some families, this may be their last holiday
together.
Delta Dental employees donated gifts for more than
100 children, thereby helping dozens of families
in difficult situations find joy in the season. "We
believe miracles happen one angel at a time," says
Bamesberger. To Delta Dental employees, she says, "Thank
you for being that angel."
She adds, "Delta Dental and Angel Connection are
really both in the same business. We're both about
smiles."
Families served year-round
This marks the 11th year of Angel Connection, which
operates out of a refurbished house on the grounds
of the Greystone Park state psychiatric hospital
in Morris County, New Jersey.
Near the holidays the house bustles with activities,
as volunteers sort, wrap and distribute gifts to
an ever-growing list of children. This past holiday
season, Angel Connection collected holiday gifts
for nearly 4,000 AIDS-affected children throughout
New Jersey and New York City.
Angel Connection operates year-round, providing many
other services for families. It holds workshops for
mothers with AIDS to help them plan for the future
of their children. "Many of them are alone in their
journey," says Bamesberger. "We help them think about
finding guardians, and show them how to go about
that."
Angel Connection holds a fall "Pumpkin Patch Picnic" to
collect coats for children. Each summer Angel Connection
prepares camp backpacks for 250 children, so they
have everything they need to go to summer camp.
One new program, called "The Shirt Off My Back," pairs
fourth graders with others the same age who have
AIDS. The students create matching shirts for themselves
and their "twins." Programs like this are designed
to educate children and adults about AIDS, and help
reduce the stigma and misunderstanding surrounding
the disease.
Much progress has been made in this area, says one
Angel Connection volunteer named Mary. Mary is a
foster parent and adoptive mother of five children
with AIDS. Two of her children died. In 1987, when
she started caring for children with AIDS, her children
weren't allowed into church play groups, her pediatrician
didn't know how to treat them, and other parents
wouldn't allow their children to play with hers.
Today, her children participate in scouting, attend
school and have play dates.
It isn't a typical life, Mary quickly adds. For a
class assignment, Mary's 11-year-old daughter recently
wrote an essay about what makes her sad. She wrote
about the deaths of her birth mother and siblings,
that she never knew her father, and her own disease. "Most
of us will never go through what she's already been
through," says Mary.
Angel Connection receives no public funding. It relies
on donations from companies and individuals to remain
in operation and continue its services. It has come
perilously close to running out of money several
times in the past year. Bamesberger worries about
the future of Angel Connection. "If we fail, there
are a lot of little children who won't get help," she
says.
For information about how to support Angel Connection,
contact:
Chaplain Carol Bamesberger
Director, Angel Connection
3 Executive Drive
P.O. Box 9123
Greystone Park, NJ 07950-9123
(973) 898-0048
Golf Classic Reminder
The 14th annual Delta Dental Golf Classic will take
place on June 23, 2004, at Fiddler's Elbow Country
Club. The event benefits Special Olympics New Jersey,
a non-profit organization that provides athletic
training and competition for children and adults
with mental retardation. We hope to see you there!
Please call (973) 285-4059 for more information.
Sidebar: Delta Dental Helps Special Olympics New Jersey
Delta Dental participates in several activities each
year to support Special Olympics New Jersey. These
include sponsoring a concert for athletes at the
2004 Special Olympics New Jersey Winter Games in
February and hosting the Delta Dental Golf Classic
in June.
Delta Dental's contributions in 2003 allowed more
than 13,500 athletes in New Jersey to train in 23
sports and compete in more than 140 events completely
free of charge.
Subscribers Give DeltaCare Dental
HMO High Ratings in Survey
A recent survey of Flagship Dental Plans' DeltaCare
managed dental care program subscribers found that
nearly 9 out of 10 are "highly satisfied" or "satisfied" overall
with their dental benefits program.
Brownstone Information Resources of Morristown, New
Jersey, conducted the survey for Flagship Dental
Plans. Flagship Dental Plans is a wholly owned subsidiary
of Delta Dental Plan of New Jersey, and underwrites
and administers the DeltaCare product.
The high overall satisfaction rating reflects strong
subscriber satisfaction in all categories. Across
the board, subscribers said they were pleased with
DeltaCare's quality of care, specialty care, access,
information provided, and customer service.
Nearly 9 in 10 subscribers are "highly satisfied" or "satisfied" with
their dentist and quality of dental treatment. In
addition, more than 8 in 10 are "highly satisfied" or "satisfied" with
their overall access to care.
In other findings, most subscribers reported that
they felt their oral health is "a great deal better" or "somewhat
better" this year. Vince Farinella, Vice President,
Flagship, says, "This speaks to the accessibility
provided by our programs, and to the quality provided
by our participating general dentists and specialists."
The survey, conducted in September 2003, was mailed
to a random sample of 1,400 DeltaCare subscribers.
Tech-Niques: How Anti-Virus Software,
Firewalls Protect Your System
By Linda Hetcher, Vice President Professional
Services, Concurrent Technologies
The Internet can bring a world of information to
our desktops. You can use it to check on patient
benefits, file dental claims, access online dental
databases, and so much more. Some people, however,
hesitate to go online because they worry about contracting
a virus, or making their systems vulnerable to a
hacker attack.
Fortunately, the solution to protecting your system
may be as close as the nearest office supply store.
Fighting viruses
A virus is a computer program file capable of attaching
to disks or other files and replicating itself repeatedly,
typically without user knowledge or permission.
Some viruses attach to files so that when the infected
file executes, the virus also executes. Other viruses
sit in a computer's memory and infect files as the
computer opens, modifies or creates the files. Some
viruses display symptoms, and some viruses damage
files and computer systems. However, neither symptoms
nor damage is essential in the definition of a virus;
a non-damaging virus is still a virus.
There are computer viruses written for several operating
systems including DOS, Windows, Macintosh, Amiga,
Atari and UNIX.
Anti-virus software helps prevent destruction generated
by a virus. Anti-virus software scans a computer's
memory and disk drives for viruses. If it finds a
virus, the application informs the user and may clean,
delete or quarantine any files, directories or disks
affected by the malicious code.
Two popular and relatively inexpensive anti-virus
packages are McAfee VirusScan, and Symantec Norton
Anti-Virus. McAfee presently detects more than 57,000
viruses. Most anti-virus packages include an automatic
update feature, which is important because new viruses
are constantly being released. Both McAfee and Symantec
Norton continuously update their virus definitions
to fight the latest viruses.
Building a firewall
A firewall is a piece of software that prevents computers
from communicating directly with external computer
systems. It acts as a barrier through which all information
passing between your computer (or your computer network)
and the external systems must travel. Firewall software
analyzes information passing between two computer
systems. If the information conforms to certain pre-configured
rules, access is allowed. If the information does
not conform, access is restricted.
This means that those trying to "sneak in the back
door" and access your private information will be
stopped in their tracks. The firewall blocks a hacker
attack.
Two popular and relatively inexpensive firewall programs
are McAfee Firewallplus and Symantec Norton Personal
Firewall. Both McAfee and Symantec Norton also offer
combined anti-virus and firewall programs in one
package.
On standalone (non-networked) computers, anti-virus
and firewall software can usually be installed without
technical support. If you operate on a network, you
should contact your computer consultant before installing
these programs.
Costs for anti-virus software and firewalls begin
as low as $35 each per year with update capabilities
for personal workstations. Bundled software packages
that include protection from both viruses and hackers
are about $80 for an annual subscription. There are
also packages that can be purchased for several PCs
that are networked together in a common office or
location for a few hundred dollars annually.
Don't leave your office computer system vulnerable.
Anti-virus and firewall programs are the first lines
of defense to protecting your system and data from
attack. They are simple to install, quickly updated
and are a very cost effective solution against viruses
and hackers.
Please note that the above products are only suggestions
and are not endorsements of any products or solutions.
We recommend that you review your individual computer
and network requirements to determine which solution
is right for your office.
Concurrent Technologies designs and develops
custom Web-based interactive solutions for a diverse
clientele ranging from Fortune 500 companies to
non-profit organizations. In the business for over
18 years, Concurrent Technologies is a total solution
provider (TSP) offering a range of services from
e-business strategy to complete technology outsourcing.
For more information, visit them at www.concurrenttechnologies.com
or call (800) 345-3895.
HIPAA's Impact on Delta Dental's
Claim Verification Activities
As a "covered entity" subject to the Health Insurance
Portability and Accountability Act (HIPAA) Privacy
Rule, Delta Dental has a vital interest in complying
with the Privacy Rule, not only in terms of its relationship
with the individuals to whom it provides dental coverage
and with the persons who purchase that coverage,
but also with its valued network of dentists.
Delta Dental's claim verification program (which
performs in-office and/or record reviews of dentists'
claims and documents and/or information pertinent
to the claims) is an important feature to Delta Dental's
groups and covered individuals. It also benefits
its network dentists who: (a) wish to compete with
other dentists on a level playing field and (b) understand
that claim verifications help level the field by
deterring and/or addressing overbilling and/or fraud
committed by dentists.
The federal government has recognized that compliance
programs and fraud and abuse detection programs serve
the public interest; consequently, the federal government's
Final HIPAA Privacy Rules contain provisions that
do not unduly interfere with such compliance programs.
The accompanying chart provides important information
concerning our claim verifications and their compliance
with the Privacy Rule. For non-Delta Dental patients,
Delta Dental will provide the needed Data Use Agreement and will
bear the cost of removing the information that directly
identifies non-Delta Dental patients (if the dentist
prefers that Delta Dental perform this).
HIPAA's Impact on Dentists' Providing Carriers
Access to Patients'
Treatment And Financial Information
1. Compliance Date
The Privacy Regulation promulgated pursuant to the
Health Insurance Portability and Accountability Act
of 1996 ("HIPAA") (and accessible at http://www.hhs.gov/ocr/hipaa/finalreg.html)
established April 14, 2003 as the Compliance Date.
45 CFR § 164.534(a)
2. Covered Entities
The Privacy Regulation does not apply to all dentists.
It applies only to "covered" dentists, who are defined
as those dentists who directly or through their agents
engage in standard transactions (such as electronic
claim submissions). 45 CFR § 164.104.
3. Release of Patients' PHI to Their Carriers or
Group Health
(a) "Covered" dentists' release of patients' protected
health information ("PHI") (which includes treatment
information and related financial information) is
subject to the Privacy Plans Regulations.
(b) The Privacy Regulations expressly permit the
release of PHI to carriers for their payment activities. § 164.506(c)(3) "Payment" is defined
to include a carrier's fulfillment of its responsibility
for coverage and provision of benefits, as well as
its providing reimbursement for health care. § 164.501 (Definition of Payment (1))
Payment activities expressly include adjudication
of claims, collection activities, review of health
care services with respect to medical necessity,
coverage under a health plan, and concurrent and
retrospective review of services. § 164.501 (Definition of Payment (2))
(c) The Privacy Regulations also expressly permit
the release of PHI of patients who are covered by
the carrier for the carrier's health care operations
involving either (i) the evaluation of the dentist's
performance or (ii) use for health care fraud and
abuse detection or compliance. § 164.56(b)(4).
4. Release of PHI of Patients not Covered by the
Carrier or Health Plan
(a) The Privacy Regulations make specific provision
for releasing PHI to carriers which do not cover
the patient where the carrier is obtaining it in
connection with its fraud and abuse detection or
compliance program so long as: (i) all facial identifiers
are removed and (ii) the carrier executes a data
use agreement with the dentist § 164.514(e).
(b) Delta Dental will be providing "data use" agreements
for files of non-Delta Dental patients from which
the direct patient identifiers have been removed.
Upon a dentist's request, Delta Dental will agree
to perform the removal of patient identifiers' information
at no cost to the dentist.
Delta Dental Promotes Electronic
Attachments with These Benefits
Free scanner courtesy of Delta Dental and NEA
While supplies last, register for National Electronic
Attachment's (NEA) FastAttach and get a free UMAX
4450 scanner. FastAttach enables you to transmit
x-rays, perio charts, photographs, EOBs, narratives,
and other attachments to Delta Dental Plan of New
Jersey, as well as 16 other Delta Dental Plans and
more than 100 other payors. For more information,
please visit www.nea-fast.com and enter DDNJ in the
promotion code box or call (800) 782-5150, ext. 2.
Dentrix offers Internet attachments
If you have Dentrix or Easy Dental practice management
systems, you may now submit digitized attachments
directly to Delta Dental via the Internet. There
is no registration fee.
For a limited time, Dentrix is offering participating
dentists 90 days of free attachments. After 90 days,
the monthly fee is $10 per month for an unlimited
number of attachments. For more information or to
register, call Dentrix at 1-800-DENTRIX (336-8749),
extension 4432.
COB FAQs
We are frequently asked for the correct way to coordinate
benefits (when a patient is covered by two or more
dental benefits plans). Delta Dental's Claims Department
provides the following tips, which apply in the vast
majority of coordination of benefits situations:
- The benefits of the plan that covers the covered
person as an employee, member, subscriber or retiree
is determined before those of the plan that covers
the covered person as a dependent.
- Coordination of dental benefits for dependents
usually (but not always) follows the birthday rule.
This means that the dental plan for the parent
whose birthday (month and day) is earlier in the
calendar year provides the primary coverage. (Delta
Dental has a small number of groups that determine
the primary carrier by the gender rule.)
- In cases of divorce, if the responsibility is
not detailed in the divorce decree, the parent
with custody is usually primary, the stepparent
is usually secondary and the non-custodial parent
is usually tertiary (third). If the parents have
joint custody, then the parent with the birthday
earlier in the calendar year usually has primary
coverage, unless stated otherwise.
- For certain oral surgery and some periodontal
surgery procedures, the medical plan is the primary
plan when those procedures are covered under that
plan, unless otherwise agreed upon by the contract
holder.
- For coordination of benefits when there are two
medical and two dental plans (for example, an eligible
dependent): Subscriber A is the parent whose birthday
month and day is first in the calendar year. Subscriber
A's medical plan would be primary, and then Subscriber
A's dental plan would be secondary. Subscriber
B is the parent whose birthday month and day is
second in the calendar year. Subscriber B's medical
plan would be third, and Subscriber B's dental
plan would be fourth.
- The benefit of the plan that covers the covered
person as an employee, member, subscriber or retiree,
or dependent of such person, shall be determined
before those of the plan that covers them under
a right of continuation (such as COBRA) pursuant
to federal or state law.
Benefits Connection Tip
If during the course of submitting a claim your
computer freezes or shuts down and you are not sure
if your claim has been submitted, here's what to
do:
1) If your computer stalls and when it reactivates
you are still logged in: Click "View Log" on the
left navigation bar to see if the claim has been
submitted.
2) If your computer completely shuts down: When you
log back in to Benefits Connection, go to "Claims
Inquiry" and check to see if the claim was submitted.
If you do not follow the above but choose to resubmit
a claim that has already been submitted, you are
creating extra work for you and for us. A duplicate
claim will be generated. If we catch the duplicate,
we can manually stop it from processing. If we don't
catch it, our system will generate an EOB, which
will deny the claim for duplication of services.
This tends to be confusing for both the member and
the dental office.
Please remember that when you hit "Submit Claim," you
are prompted to wait until our system has had sufficient
time to process your claim. On the next screen, you
will learn if your claim has been adjudicated or
pended for further review.
Also, if you are having problems with Benefits Connection
and you feel it is not a problem with your computer,
you should call the Benefits Connection Help Desk
at (888) 783-5750.
Thank you for your cooperation. If you would like
more information about Benefits Connection, please
call your dental network coordinator at (888) 396-6641.
Sidebar: Customer Service Offers Benefits Connection Capabilities
Customer Service agents have direct access to www.deltadentalnj.com,
Delta Dental's Web site. This makes it possible for
them to log onto Benefits Connection at the same
time they are on the phone with you.
Because they can view the same information and computer
screen that you see when you log onto Benefits Connection,
they can help answer your questions and guide you.
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