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Articles
Delta Dental to Launch Dental Access
Plan for Uninsured
Orthodontic Usual, Customary and
Reasonable Pricing to Begin January 1, 2006
How Benefits Connection Helps Our Practice:
Grace Schlemm, Clifton Endodontics
Using the Internet Creates Positive Impact
to Practice
Reminder: New COB Policy Becomes Effective
January 1
Dental Director Writes Article on Childhood
Tooth Decay in School Nurse News
Employees Contribute Time, Money to Help
Katrina Victims
Services Submitted on Claims Must be Performed,
or It's Fraud
ADA News Urges More Dentists to Use
E-Claims
Online Brush Biopsy Training Available
Dentist Handbook Available Online
Delta Dental to Launch Dental
Access Plan for Uninsured
Delta Dental of New Jersey is pleased to announce
that we will soon begin offering Delta Dental Patient
Direct, a dental access plan, to the approximately
4 million New Jersey residents who are without dental
insurance. We are communicating this service to potential
members through a public education and advertising
campaign.
Delta Dental Patient Direct offers dentists the potential
to increase their patient base. To date 1,300 general
practice and specialty dentists offices have signed
up to participate in this new program.
Members who enroll in Delta Dental Patient Direct
gain access to a network of Delta Dental Patient
Direct participating dentists and specialists who
agree to accept the lesser of their actual fee, usual
fee, or the Delta Dental Patient Direct fee as payment
in full.
Delta Dental Patient Direct is different from our
dental benefits plans (such as Delta Dental Premier
and Delta Dental PPO.) Delta Dental Patient Direct
members are responsible for paying for all services
and making these payments directly to the dentist.
Participating Delta Dental Patient Direct dentists
will not submit claims to Delta Dental or be concerned
with deductibles, co-payments and maximums.
In fulfilling our corporate mission, Delta Dental
developed Delta Dental Patient Direct for New Jersey
residents who do not have dental insurance.
For more information about Delta Dental Patient Direct
and how to enroll, please contact your dental network
coordinator at (888) 396-6641, visit us at www.patientdirectnj.com,
or e-mail us at ddsrelations@deltadentalnj.com.
Orthodontic Usual, Customary
and Reasonable Pricing to Begin January 1, 2006
Effective January 1, 2006, Delta Dental of New Jersey
will begin paying orthodontic claims based on the
lesser of the Delta Dental Participating Dentists
Maximum Approved Fee (formerly referred to as the “customary
fee”), the dentist’s fee on file (“usual
fee”), or the dentist’s submitted charge.
This is the same process followed by Delta Dental
of New Jersey for all other non-orthodontic claims.
Participating dentists should make sure that their
filed fees for orthodontic procedures are up to date.
Delta Dental uses CDT-2005 terminology and procedure
codes for processing orthodontic claims. For your
convenience, an abbreviated
fee filing form is included in this issue of
Dental News.
When submitting claims, any case with extenuating
circumstances should be submitted with documentation
for individual consideration. All participating dentists
should review Chapter 8 of our Participating Dentist
Handbook, which provides Delta Dental’s procedures
for billing orthodontic claims. (To access the Participating
Dentist Handbook online, visit our Web site at www.deltadentalnj.com;
click “Dentists” and log onto Benefits
Connection. Then click “Participating Dentist
Handbook” on the left navigation bar.)
As a reminder, below are Delta Dental’s processing
policies that apply to orthodontic procedures:
- The fee for a course of orthodontic treatment
(CDT-2005 procedure codes D8010-D8220) includes
all appliances, office visits, and follow-up visits
(including retention). Accordingly, procedures
D8670 and D8680 should not be billed or collected
from a Delta Dental member as a separate charge
when the dentist/dental office has provided limited,
interceptive, or comprehensive treatment to the
same patient.
- The fee for the course of treatment does not
include fees for orthodontic records, which should
be listed separately using CDT-2005 code D8660.
- The fee for a course of orthodontic treatment
does not include additional charges for cosmetic
banding, Invisalign, repair or replacement of orthodontic
appliances. Additional charges for these procedures
are the responsibility of the patient.
If you have questions, please call our Professional
Relations Department at (888) 396-6641 for more information.
How Benefits Connection Helps
Our Practice: Grace Schlemm, Clifton Endodontics
Patients at Drs. Ronald Deblinger and Leslie Elfenbein’s
practice in Clifton, New Jersey, better understand
their dental benefits coverage now that Grace Schlemm
uses Delta Dental’s online Benefits Connection,
Schlemm, who is office manager for Clifton Endodontics,
started using Benefits Connection three years ago
to verify patient benefits. She recently began submitting
online pretreatment estimates (PTEs) and claims,
as well.
Most PTEs and online claims are processed immediately,
which means Schlemm can tell patients exactly what
they need to know about their financial obligation.
“Benefits Connection makes it much easier to communicate to patients
about what benefits are covered by their dental plan and what their financial
responsibility is for treatment,” says Schlemm. “I go online while
patients are still in the office. I find that when I can tell patients upfront
about their out-of-pocket responsibility, they are much more willing to pay.”
Although she must also enter claim information submitted
through Benefits Connection into the office’s
practice management system, Schlemm says a little
extra keying is worth it. “I don’t have
to issue refund checks or balance bill. It’s
a really useful tool to aid in collection from Delta
Dental patients.”
Benefits Connection enables dental offices to verify
patient benefits and eligibility, check claim status
and file claims online. The service is available
24 hours a day, seven days a week, at www.deltadentalnj.com;
click "Dentists" and then the "Logon" button in the
Benefits Connection Logon box.
If you've never used Benefits Connection, click "Register
Now" in the Benefits Connection Logon box to get
started. To see what's available through Benefits
Connection, click "Benefits Connection Demo" and
try the online demonstration.
Using the Internet Creates Positive
Impact to Practice
Linda Hetcher Vice President of Professional
Services
Concurrent Technologies
Wouldn’t it be great to lower your claims processing
costs, reduce paperwork, improve cash flow and increase
patient satisfaction?
All of this is possible when you file claims over
the Internet.
The Internet makes it possible for dental offices
to easily access patient benefit information from
dental benefits carriers such as Delta Dental.
Delta Dental’s Benefits Connection (www.deltadentalnj.com;
click “Dentists”), for example is a full-featured
online tool designed to streamline your office operations
and improve productivity. It enables you and your
staff to immediately review your patients’ benefits
and eligibility, as well as submit claims electronically
in real time.
You may have heard about these capabilities before,
but the question remains: What does this mean to
your practice on a daily basis? The answer is that
the Internet can positively change the way everyday
administrative activities within your office are
handled. This can have far-reaching impacts on the
efficiency of your practice.
Being able to access patient benefits information
online delivers value to you in the following ways:
- Confirm patient eligibility before treatment
is administered. Knowing coverage levels
and patient financial responsibility eliminates
the problems encountered when a patient overpays
or underpays. You can also work collaboratively
with your patients to determine a viable care
and treatment plan.
- Eliminate submission of incorrect procedure
codes. This reduces errors that can delay
claims processing and payments.
- Reduce time spent determining claims status. Going
online is faster than tracking down information
manually. Everything you need is at your fingertips.
- Receive payments much quicker. Using the
Web to submit claims shortens the revenue cycle.
Payment is about 50% faster than with paper claims.
- Improve service for patients. With accurate
information readily available online, it’s
simple to find out detailed information about your
patients’ benefits. Information can be printed
by the office manager for the patient to see. Better
yet, patients can be directed to go online themselves
to understand their plan coverage.
With the maturing of software and technology, especially
with Web-based solutions, dental practices can take
advantage of applications such as Benefits Connection.
Like most industries, the delivery of dental services
is becoming increasingly competitive. Operational
efficiencies offered through Web sites such as Delta
Dental’s not only help manage costs and improve
revenue cycles but also increase patient satisfaction.
That remains the strongest long-term positive impact,
no matter what the nature of your practice.
Concurrent Technologies designs and develops
custom Web-based interactive solutions for a diverse
clientele ranging from Fortune 500 companies to
non-profit organizations. In 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.
Side Bar: Internet Filters Explained
It’s certainly arguable that the Internet is
one of the greatest inventions of all time. However,
some practices may be concerned that the productivity
gained by using it may be offset through random surfing
of the Web.
One solution for those with this concern may be Internet
filtering. Originally designed to protect children
from offensive or dangerous content on the Web, it
is now available for businesses. In essence it provides
the ability to control what content and which Web
sites (often called a “yes list” or “white
list”) are accessible on individual PCs within
your office. There are a number of highly rated packages
that are relatively inexpensive to install and quite
effective at filtering.
There is no perfect Internet filter, but like all
software these packages are becoming more sophisticated
while keeping costs in check. They generally range
from $30 to $70 depending on feature sets. The key
things to consider before purchase are ease of use,
installation requirements and options available.
Some Internet filters on the market include:
Please note that neither Delta Dental nor Concurrent
Technologies endorses or recommends any of the above
Internet filter products. They are included for informational
purposes only.
Reminder: New COB Policy Becomes
Effective January 1
Starting January 1, claims for most oral surgery
procedures, along with general anesthesia, must be
submitted to the subscriber’s primary medical
plan before being submitted to Delta Dental. We will
require a medical Explanation of Benefits (EOB),
even if the claim submission states that there is
no other coverage or fails to address it.
The procedure codes that require medical EOBs and
the documentation requirements for those codes can
be found on our Web site (www.deltadentalnj.com)
by clicking “Dentists,” and then “Required
Documentation Charts.”
In addition, many medical insurers will also pay
for services such as exams and x-rays when done in
conjunction with these oral surgery procedures. Please
send Delta Dental the primary medical carrier Explanation
of Benefits so we may properly coordinate benefits.
Dental offices can contact Customer Service at (800)
452-9310 to obtain a list of groups that have designated
Delta Dental as primary for the above procedures.
Dental Director Writes Article
on Childhood Tooth Decay in School Nurse News
Hidden sugar in many popular foods contributes to
tooth decay in children, writes Dr. Scott Navarro,
Delta Dental’s dental director, in the September
2005 issue of School Nurse News.
While this isn’t surprising news to dentists,
it is an important message to communicate to school
nurses and others who serve children and adolescents
in the school setting.
School Nurse News provided an excellent means of reaching this audience.
The subscription-based magazine goes to 11,400 school nurses and other healthcare
professionals who serve children and adolescents in school settings. School
Nurse News is published every other month during the school year. The magazine
regularly features articles on oral health, as well as other children’s
health issues relevant to school nurses.
Employees Contribute Time, Money
to Help Katrina Victims
Delta Dental and our employees have united to support
the victims of Hurricane Katrina. The company matched
100% of employee donations to the American Red Cross
Hurricane Katrina relief efforts. Employee and company
donations to the Red Cross’ hurricane relief
efforts totaled more than $12,000.
The company also sent golf shirts to survivors. All
of the Delta Dental Plans nationwide are working
with dentists from Louisiana, Alabama, and Mississippi
who lost their patient records.
Customer Service Agent Cindy Beahm took three weeks
off from work to volunteer with the Red Cross. Many
employees supported Beahm, who did not have any vacation
time left for the year, by donating their unused
vacation time to her. Beahm worked in a warehouse
in Alabama unloading and organizing donated goods
and delivered goods to a church in Mississippi.
“Seeing the destruction caused by Hurricane Katrina sparked an uprising
of human compassion on every level of our organization,” said Walt VanBrunt,
president and CEO. “I am proud to be a part of this company and work
with such compassionate people.”
Services Submitted on Claims
Must be Performed, or It's Fraud
A dentist must only submit claim forms to third-party
payers that reflect dental services or procedures
actually rendered.
Billing for a service that has not been performed
may be intentional. “Extra” unperformed
services or procedures may be added to a claim form
because reimbursement for these services may cover
the cost of non-covered services or defray the patient’s
co-payment or deductible responsibility.
Conversely, submitting a claim for payment for services
or procedures that do not appear on the patient’s
treatment chart or financial ledger may be the result
of an office policy. For example, it might be standard
office policy to add a fluoride treatment to every
child prophylaxis because this particular combination
of services is usually performed. In some cases,
the fluoride treatment may not have been administered
to a specific patient.
In both cases, submitting for services or procedures
that have not been performed is one of the unacceptable
billing practices reviewed during claim verification.
Billing in this manner can result in overpayments
that are recoverable. If a claim form is intentionally
submitted for services or procedures that have not
been performed, it can be considered a fraudulent
attempt to gain benefits.
For more information, please refer to:
- New Jersey State Board of Dentistry, Administrative
Code [NJAC 13:30-8.10]
- The General Statutes of Connecticut [Volume 7,
Title 20, Chapter 379 Sec. 20-114]
- The Delta Dental of New Jersey Participation
Agreement
- The Delta Dental of New Jersey Handbook for Participating
Dentists, Chapter 11, Claim Verifications
ADA News Urges More Dentists
to Use E-Claims
The June 6 issue of ADA News focused on
the many advantages of filing electronic claims.
According to the article “E-claims boon for
dentists” by Arlene Furlong, e-claims:
- Are processed twice as fast as paper claims.
- Help patients understand the cost of treatment
before service is rendered.
- Help dentists determine a patient’s financial
responsibility during the first office visit.
- Lower claims processing costs.
- Reduce paperwork.
Dr. Michael L. Stuart, chairman of the American
Dental Association’s Council on Dental Practice,
said he would have started using e-claims earlier
if he had understood their advantages. “I only
wish I’d done it sooner. It’s natural
to feel a little apprehensive about going to a computer-based
records system. But I’ve never known a dentist
to regret it.”
ADA News plans to run additional articles
about how e-claims can help dental practices improve
efficiency and profitability.
Online Brush Biopsy Training
Available
The brush biopsy is a relatively new procedure for
testing patients with unexplained red and white lesions
for oral cancer. Delta Dental now offers brush biopsy
as a benefit. We also offer free online training
on brush biopsy. For information, please visit our
Web site at www.deltadentalnj.com and click “Oral
Cancer Training” in the “What’s
New” box.
Please note this course may or may not qualify for
continuing education credits by state dental boards.
Dentists should check with their respective state
boards to determine if continuing education credits
are available.
Dentist Handbook Available Online
Participating dentists in New Jersey and Connecticut
should already have received our new Participating
Dentist Handbook on CD. It is also available online
for participating dentists. Go to www.deltadentalnj.com,
click “Dentists” and log onto Benefits
Connection. Then click “Participating Dentist
Handbook” on the left navigation bar.
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