Articles
One Client Tells Why They're Still with Us 35 Years Later
New Training Discounts Offered for Participating Dentists
Final Rule Announced for National Provider Identifier (NPI)
PANDA Program Fights Child Abuse
Dental Staff Learn How to Check Patient Benefits, File Claims Online at Benefits Connection Day
Golf Classic Reminder
Claims, Customer Service Performance Quality Remain High in 2003
Delta Dental Revises EOB
Delta Dental Promotes Peggy Marvin to Assistant Vice President of Claims
Tech-Niques: Protecting Sensitive Patient Information Online

One Client Tells Why They're Still with Us 35 Years Later

Wheaton Industries chose the fledgling Delta Dental Plan of New Jersey to provide dental benefits for its employees in 1969. Thirty-five years later, despite many changes to the business, their relationship with Delta Dental endures. David Slack, director of Health and Welfare Plans at Alcan Packaging Pharmaceuticals and Personal Care (the new name for Wheaton Industries), knows why.

"We've looked at other programs over time, but what has kept us with Delta Dental is good service, good pricing, a good network, and the ability to design the program the way we want to design it," says Slack. "You've been very flexible and very cost effective."

Slack has administered the Delta Dental program for the past 25 years. He thinks his predecessor, his father Neal Slack, may have signed the original contract. 

Alcan Packaging, based in Millville, New Jersey, employs 2,200 employees. It has been acquired twice and gone through multiple name changes in the past six years. "Delta Dental has certainly changed as our needs changed," says Slack. 

He adds, "You keep doing things right. I'm not a person who makes changes quickly or easily, but I do make them when there are good reasons. I'm a very analytical person. I've always found that Delta Dental hasn't made mistakes that have forced me to look elsewhere. You've always maintained a program that is attractive both operationally and financially.

"It's been a good relationship. Nobody has given me reasons to look elsewhere, and when I have looked to see if you're the best deal, you're still the best deal. Congratulations for a wonderful 35 years!

New Training Discounts Offered for Participating Dentists

Delta Dental Plan of New Jersey has added a new value-added service to help support our participating dentists. 

ProBusiness Online has offered to bring online Occupational Safety and Health Administration (OSHA) and Health Insurance Portability and Accountability Act (HIPAA) training to Delta Dental participating dental offices at a 30 percent savings. ProBusiness Online is a recognized American Dental Association Continuing Education Recognition Program (CERP) provider and offers continuing education (CE) credit for all courses. Eight hours of CE credit is awarded for OSHA and six hours for HIPAA training. 

Participating dentists can train up to 10 staff members on OSHA for $69 and on HIPAA for $56. The OSHA and HIPAA courses include unlimited access for one year, including access for new employees hired during the year.

ProBusiness Online courses are available 24 hours a day, seven days a week, allowing office staff to study at their own pace.

ProBusiness Online also offers a comprehensive suite of online CE, with more than 200 courses available to participating dental offices at a 15 percent savings. Several courses have been specifically designed for dental assistants and front office staff.

A link is being developed from the Delta Dental portal to ProBusiness Online to allow providers to register for OSHA and HIPAA courses, or browse through the CE course library. To access this value-added service, simply register on the Delta Dental Plans Association portal at www.deltadental.com.

Final Rule Announced for National Provider identifier (NPI)

One provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) called for establishing a standard unique identifier for health care providers. 

The Centers for Medicare & Medicaid Services (CMS, formerly the Health Care Financing Administration or HCFA) recently published the Final Rule, which adopts the National Provider Identifier (NPI) as the standard identifier. 

The rule becomes effective on May 23, 2005. Health care providers, including dentists, may apply for NPIs beginning on that date. 

All covered entities, except small health plans, must fully comply with the rule by May 23, 2007. Small health plans have until May 23, 2008. When the NPI is implemented, covered entities will use only the NPI to identify health care providers in all standard transactions. 

The NPI will replace any other provider identifier that health plans today require for standard transactions. Health care providers will no longer have to keep track of multiple numbers to identify themselves in transactions with one or more health plans. (However, the Taxpayer Identification Number may also need to be reported for tax purposes as required by the implementation specifications.) 

It is expected that the use of the NPI will simplify transactions, including claims and coordination of benefits, and save money in the long term.

The NPI is a numeric 10-digit identifier. It contains no embedded information about the health care provider that it identifies. The assigned NPI does not expire. At the current rate of health care provider growth, NPIs can continue to be assigned for 200 years. 

All health care providers are eligible for NPIs. Health care providers who transmit health information electronically are covered entities, and are required to obtain and use NPIs. Health care providers who are not considered covered entities may also apply for an NPI. Health care providers are not required to conduct electronic transactions; however, those that do will be required to obtain NPIs. 

In certain situations, it is possible for "subparts" of organization health care providers (such as hospitals) to be assigned NPIs. These subparts may need to be assigned NPIs in order to conduct standard transactions on their own behalf or to meet federal regulatory requirements related to their participation in health plans such as Medicare. The Final 
Rule requires covered health care providers to determine if they have subparts that may need NPIs and, if so, to obtain NPIs for the subparts or require the subparts to obtain their own NPIs. The subpart concept does not pertain to health care providers who are individuals. 

Health care providers will be assigned NPIs after completing an application form. The preferred method of form submission will be over the Internet but may also be submitted on paper. Once a health care provider has been assigned an NPI, the provider must update any changes to its data within 30 days. In most cases, the process of obtaining an NPI will require a dentist to provide a minimal amount of information: name, address, telephone number, Taxonomy Code, authorized official's name and telephone number, and contact person's name and telephone number. Delta Dental Plan of New Jersey is looking at ways to assist our participating dentists in obtaining an NPI.

The National Provider System (NPS), being built under a CMS contract, will process the applications and updates, ensure the uniqueness of the health care provider, and generate the NPIs. The NPS will be able to produce reports and information based on requests from the health care industry and others. 

A single entity, known as the enumerator, will operate the NPS under a contract with CMS. The enumerator will receive applications and updates from health care providers. The enumerator will assist health care providers in completing applications and in furnishing updates, and will be responsible for resolving problems and answering questions. The enumerator will notify the health care providers of their NPIs. The enumerator will also process requests for, and disseminate information containing, health care providers' NPIs. HHS will prepare a Federal Register Notice describing the NPS data dissemination policy. 

The process of obtaining an NPI will not eliminate Delta Dental Plan of New Jersey's continued need to collect participation agreement information, including credentialing and recredentialing data.

Information about NPI implementation, including information on how to apply for NPIs, will be made available to the health care industry by CMS closer to the effective date. 

NPI at a Glance

Who needs an NPI?
Any dentist who transmits protected health information electronically

When should I apply for an NPI?
After the Final Rule goes into effect, on May 23, 2005

When must I start using my NPI?
On or before May 23, 2007

How do NPIs benefit me?
You use the same 10-digit number to identify yourself in transactions with all health plans

PANDA Program Fights Child Abuse

Would you be able to recognize an abused child?

The signs aren't always obvious. That's why the Delta Dental Foundation offers its PANDA (Prevent Abuse and Neglect through Dental Awareness) program to those who are in regular contact with children. 

PANDA was originally created for dentists, who are well positioned to detect child abuse. Two out of three injuries occur to the head, face, and neck areas, which are readily visible during a dental exam. 

The PANDA program recently expanded to include medical professionals, teachers, school nurses, youth group leaders, and other community group leaders who can assist in the fight to combat devastating patterns of abusive behavior.

PANDA presentations provide detailed information on physical and behavioral indicators of child abuse and neglect. They teach how to report suspected abuse and how to deal with the sensitive issues involved in filing a report. 

The PANDA presentation is a one- to three-hour slide program and workshop conducted by trained professionals. If you are interested in attending a presentation or scheduling one for your group, please call (973) 944-4555.

Delta Dental Supports Blue Ribbon Campaign Against Child Abuse 

Delta Dental is an annual sponsor of the Prevent Child Abuse-New Jersey (PCA-NJ) Blue Ribbon Campaign, which takes place each April during National Child Abuse Prevention Month.

PCA-NJ, with the help of hundreds of volunteers, distributes more than 250,000 blue ribbons throughout New Jersey. The ribbons remind people of the tragedy of child abuse and what they can do to help prevent it. 

For more information on PCA-NJ or to learn about becoming a volunteer for the Blue Ribbon Campaign, please call (732) 246-8060 or visit PCA-NJ's Web site at www.preventchildabusenj.org.

For information about other programs to prevent child abuse, visit the U.S. Department of Health and Human Services' National Clearinghouse on Child Abuse and Neglect Information at http://nccanch.acf.hhs.gov/.

Dental Staff Learn How to Check Patient Benefits, File Claims Online at Benefits Connection Day

Delta Dental recently presented a new educational program that focuses on how dental offices can use the online Benefits Connection to improve productivity. 

Delta Dental's Benefits Connection enables dental offices to use the Internet to access information about a patient's eligibility and benefits, and file claims. 

The two-hour Benefits Connection Day sessions were offered on March 26 and March 31 to representatives from high volume dental offices with computers. They were held at Delta Dental's headquarters in Parsippany, New Jersey.

Speakers included two current Benefits Connection users. Sandy Van Kluyve, assistant office manager for Dr. Brian Trava, who has several locations in New Jersey, presented on March 26th. Eileen Leoncini, office manager with Towne Center Family Dental in Hillsborough, New Jersey, presented on March 31st. Both practices are among the top five users of Benefits Connection. 

Sessions also included skits to illustrate how Benefits Connection can improve dental office productivity, and a step-by-step demonstration of Benefits Connection by Beth DeCapio, dental network coordinator. Delta Dental's Web master, Betty Hill, registered new users.

Mary McKenna, office manager at Dr. John Carollo's office in Florham Park, New Jersey, won a Tungsten T2 Palm handheld computer and software, valued at $500, in a raffle. All participants received two continuing education credits.

If you would like to be invited to a future Benefits Connection Day session, please contact Betty Hill (973) 285-4061, or e-mail her at bhill@deltadentalnj.com. If you would like to schedule an office visit from our Professional Relations staff, please call (888) 396-6641. 

You don't need to wait for a demonstration before you try Benefits Connection, however. It's designed so even first-time users are guided easily through it. There's also an online demo if you want extra practice before trying the real thing. To access to Benefits Connection, go to www.deltadentalnj.com and click "Dentists." If you're ready to get started, click "Register Now" in the Benefits Connection Logon box. For the demo, click "Benefits Connection Demo."

Golf Classic Reminder

Please join us at the 14th annual Delta Dental Golf Classic! It takes place on June 23, 2004, at Fiddler's Elbow Country Club in Bedminster, New Jersey. The event benefits Special Olympics New Jersey (SONJ). SONJ is a non-profit organization that provides athletic training and competition for children and adults with developmental disabilities. We hope to see you there!

Call (973) 285-4059 for more details. The invitation and registration form are available online at www.deltadentalnj.com; click "Dentists," "Schedule of Events," and "Registration Form."

Delta Dental Helps Special Olympics New Jersey

Delta Dental supports Special Olympics New Jersey all year long. We hosted a concert for athletes at the 2004 Special Olympics New Jersey Winter Games in February and will host 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.

Claims, Customer Service Performance Quality Remain High in 2003

Delta Dental processed a record number of claims, while continuing to maintain excellent service levels in 2003, according to the company's 2003 Operations and Customer Service Reports. Here is a glimpse at some of our 2003 statistics:

Number of claims processed
Nearly 3 million (nearly 4% more than last year)

Average claim cycle time
9.1 business days (7.51 business days for electronic claims)

Customer Service call volume
Nearly 892,000 calls

• 634,000 handled by Customer Service agents
• 258,000 handled by automated voice response system

Despite growth in claims and the number of subscribers, call volume is down 3.5%. A growing number of dentists and subscribers use Delta Dental's Internet site for answers to their benefits, eligibility and claims questions.

Accuracy rates
Key accuracy measures--clerical accuracy, payment accuracy and dollar accuracy--all 99% or higher

Dental network size-New Jersey

• 6,076 DeltaPremier participating dental office locations
• 3,712 Delta's Advantage Program dental office locations
• 3,023 DeltaPreferred Option dental office locations

Dental network size-Connecticut

• 2,416 DeltaPremier participating dental office locations
• 1,077 DeltaPreferred Option dental office locations

Dental network growth-New Jersey
Added:

• 511 DeltaPremier office locations
• 394 Delta's Advantage Program office locations
• 369 DeltaPreferred Option office locations

Dental network growth-Connecticut
Added:

• 323 DeltaPremier office locations
• 199 DeltaPreferred Option office locations

Delta Dental Revises EOB

Delta Dental has recently revised its Explanation of Benefits (EOB) form. You will see that the term "allowed amount" has been replaced with "Amount Used for Benefit Calculation." Our intention is to provide greater clarity. In addition, both the "approved amount" and "Amount Used for Benefit Calculation" are defined in the EOB so dentists and subscribers have a clear understanding of those terms. 

Approved amount is "The total amount which the dentist is permitted to collect as payment in full for the specified service. It includes the dental benefit plan's payment as well as the patient's deductible and/or copay."

Amount Used for Benefit Calculation is "The fee amount that the dental benefit plan provides for use in calculating the dental benefit plan payment for the specified service. The dental benefit plan payment may be less than this fee amount due to patient deductible, copay, plan limitations or exclusions."

You will soon be seeing changes in other Delta Dental documents as we discontinue use of "UCR" and "Prevailing Fee" terminology. Look for these changes when you receive your new Participating Dentist handbook later this year.

Delta Dental Promotes Peggy Marvin to Assistant Vice President of Claims

Delta Dental announces the promotion of Peggy Marvin to assistant vice president of Claims.

Ms. Marvin began her career with Delta Dental in June 1998 as director of Claims, responsible for the Pre-Edit, Data Entry and Dental Audit Departments. During her tenure, claims grew from 1.85 million to 2.95 million claims annually, which represents a 59 percent increase. She also assisted in the implementation of U.S. Department of Labor regulations, American Dental Association's CDT procedure codes and Health Insurance Portability and Accountability Act (HIPAA) privacy policies.

Prior to joining Delta Dental, Ms. Marvin was employed by Chubblife America as a claims manager. Before that, she worked for four years at Aetna in health and dental claims processing.

"Peggy has been instrumental in keeping our claims operation functioning efficiently, which has been imperative, especially during a period of substantial growth," said Walter VanBrunt, president and CEO. "She is integral to ensuring Delta Dental Plan of New Jersey is current with all industry standards and regulations, and will undoubtedly continue to contribute to the company's success in the future."

During her career, Ms. Marvin has taken coursework to advance her knowledge and status within the industry. She earned professional designations such as Health Insurance Associate (HIA), Associate Life and Health Claims (ALHC) and Managed Health Care Professional (MHP).

Tech-Niques: Protecting Sensitive Patient Information Online
By Linda Hetcher, Vice President Professional Services, Concurrent Technologies

The Internet makes transmitting and retrieving information easier than ever. Dental offices can use the Internet to submit claims electronically, and find details about their patients' dental benefits and claims history with a few clicks of a mouse.

But how secure is your patients' protected health information as it travels over the Internet? This article explains how information is kept safe from unauthorized eyes and maintains compliance with the Health Insurance Portability and Accountability Act's (HIPAA's) privacy rules while using the Internet. 

Technology is available today to not only protect patients' private information, but also helps dental offices protect their own information. For example, this technology is used in secure online purchasing. Knowledge of this technology can help dental offices bolster patient trust by being able to explain how they protect patient information online. It also helps dental offices operate more efficiently, since they feel more confident using technology, and its time- and cost-saving solutions, to its fullest.

How Delta Dental protects information
Delta Dental registered its Web site through a certifying authority (CA). A CA is a third-party company that confirms the identity of a business and supports the secure transfer of data over the Internet. Delta Dental uses VeriSign, but there are other CAs as well. The popular auction site eBay uses Trust.e. However, all CAs operate similarly. 

Just below the left navigation bar on Delta Dental's home page (at www.deltadentalnj.com) is a yellow rectangular box that reads, "Web identity verified by VeriSign." Clicking on this box displays a pop-up screen from VeriSign, which provides information about the identity of the Delta Dental Web site, including the URL or domain name of the site, company name, and dates of validity of the certificate. Certificates can be purchased for one- or two-year periods.

The pop-up screen also indicates that Delta Dental has an SSL (secure socket layer) certificate. The SSL certificate is an electronic file for Delta Dental's Web server. It is an electronic credential that assures users that its transactions are done in a secure way.

A business' SSL certificate is a bit like the passport a traveler presents to authorities. The SSL certificate and passport both validate identities. 

What SSL certificates mean to Web site users
The SSL certificate ensures three things:
* Authentication. It says that the organization that owns the Web site is a legal entity and that it has the right to use the domain name. (In Delta Dental's case, the domain name is www.deltadentalnj.com.) It ensures that Web site operators are who they say they are. 
* Privacy. Data exchanged between the user and the site is encrypted, or made unreadable, until it arrives at its destination.
* Integrity. Information carried between the user's desktop and a Web site such as Delta Dental's can't be tampered with. What is sent is what is received.

Secure areas of Web sites
Certain areas of some Web sites are secure. For example, Delta Dental's Benefits Connection area is one such area. Only transactions that take place in secure areas of Web sites are truly private. While e-mail is not necessarily protected over the Internet, information sent to Delta Dental's Customer Service Department using the Contact Customer Service Form through Benefits Connection (which resides in a secure area of the Web site) is secure.

How do you know if you're in a secure area of a Web site?

Check the URL or site address. It will begin with https rather than http when in a secure area. In most cases, you must provide an ID and password to access applications and private data through a secure area. 

When in a secure area, the right hand side of the bottom toolbar will have a lock icon. Clicking on the lock provides information about the SSL certificate.

SSLs make secure Internet transactions possible
Internet users want to be assured that the Web sites they visit are legitimate, and that those sites take the proper steps to protect privacy. When you navigate the seemingly faceless 'Net, SSLs provide third-party verification that you're communicating with whom you're communicating, and that any information exchanged will travel securely. SSLs are an important component to making Internet transactions secure.

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.