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Articles
New Program for Uninsured Begins
Delta Dental Launches New Brand
Initiative
Important Notice to Delta Dental Participating
Dentists
Captain Supertooth Video Now in
Spanish
Calling All Dentists!
Waiving a Patient Copayment? You
Must Let Us Know
Employee Named Customer Service
Representative of the Year
Employees, Delta Dental Contribute
$8,700 to Fight Breast Cancer
Golf Outing Raises $50,000 for SONJ
Delta Dental Sponsors Fifth Dental
Hygiene Program in New Jersey
Two Dental Network Coordinators
Win National Delta Dental Award
New Program for Uninsured Begins
Delta Dental recently launched an extensive billboard
and radio campaign to promote our new dental access
plan for New Jersey residents without dental insurance.
Called Delta Dental Patient Direct, the program is
now enrolling new members by telephone and the Internet.
Delta Dental Patient Direct offers dentists the potential
to increase their patient base. More than 1,300 general
practice and specialty dental offices have already
signed up to participate in this new program.
Members gain access to a network of Delta Dental
Patient Direct participating dentists and specialists.
Participating dentists 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 not insurance and
is different from our dental benefits plans (such
as Delta Dental Premier and Delta Dental PPO). Members
pay for all services, and make payments directly
to the dentist. Participating Delta Dental Patient
Direct dentists submit no claims to Delta Dental,
so there are never any issues concerning deductibles,
copayments or maximums.
For more information about how to become a participating
Delta Dental Patient Direct dentist, please contact
your dental network coordinator at (888) 396-6641.
You can visit us at www.patientdirectnj.com, or e-mail
us at ddsrelations@deltadentalnj.com.
Delta Dental Launches New Brand
Initiative
Before today, everyone knew us as Delta Dental Plan
of New Jersey. Now, we’re Delta Dental of New
Jersey, Inc.
The new name is part of our comprehensive branding
strategy. All printed materials will conform to the
new product names and brand identity no later than
January 1, 2007.
Over the past year, we participated in a nationwide
initiative by the Delta Dental Plans Association
to develop a strong Delta Dental brand. The effort
involved more than making changes to our visual identity.
We developed strategies to connect with all of our
stakeholders, and communicate who we are and what
we do. Our brand ensures we are clearly differentiated,
and builds long-term credibility, awareness and recognition
so that customers choose us.
We will be introducing a new logo and new corporate
colors, such as “rejuvenating green” and “healthy
pink.” We are also refreshing our typeface,
images and other elements to build a more distinctive
brand.
Product names are also changing to emphasize the
Delta Dental identity. The new product names are:
- Delta Dental Premier (formerly DeltaPremier),
our fee-for-service program.
- Advantage Program (formerly Delta’s
Advantage Program), which is available only in
New Jersey, and offers access to dental care provided
by a large network of participating dentists on
a fee-for-service basis, while allowing freedom
of choice in dentist selection and lower dental
plan costs.
- Delta Dental PPO (formerly DeltaPreferred
Option), in which participating dentists accept
the Delta Dental PPO schedule of fees as payment
in full, offering guaranteed co-payments to eligible
patients using network dentists. Subscribers may
also select a Delta Dental Premier dentist who
is not a Delta Dental PPO dentist, although out-of-pocket
costs may be higher.
- DeltaCare (name remains the same), which
is the coverage provided by our capitated dental
health maintenance organization (dental HMO-type
program), Flagship Dental Plans.
Also, we will no longer use the term “DeltaUSA” or “USA” after
any product name. Instead of “DeltaUSA” or “Delta
Premier USA,” we will use “Delta Dental” with
the applicable product name, such as “Delta
Dental Premier.” The one exception to this
is DeltaCare.
Important Notice to Delta Dental
Participating Dentists: Delta Dental to Change
Participating Dentist Maximum Approved Charge Fee
Calculation Method, Effective January 1, 2007
As a Delta Dental participating dentist, you are
integral to our success. Delta Dental of New Jersey
(DDNJ) wishes to advise you of important changes
to the way we will calculate the Participating Dentist
Maximum Approved Charge (PMAC), which was previously
known as the “customary fee.” The change
will impact Delta Dental Premier, Advantage and Delta
Dental PPO Programs to the extent that those programs
base payments on the PMAC (e.g. specialist payments).
Delta Dental Premier is an important source of patients
for our participating dentists. Patients are referred
to Delta Dental Premier participating dentists through
listings in our printed network directory and also
by clicking “Find a Dentist” on our Web
site. Therefore, it is important to maintain the
viability and market share of the Delta Dental Premier
program.
Due to their relatively high cost of dental services,
our Delta Dental Premier program (“UCR” type
program) and similarly positioned programs have been
steadily losing market share to managed care preferred
provider organization (PPO) programs. Because of
the increased costs of “fee-for-service” type
programs, employers are searching for alternatives,
including options that may severely limit patients’ freedom
to choose their own dentists.
After lengthy deliberation about how to best keep
Delta Dental Premier a viable purchasing choice in
the dental marketplace, we have concluded that adjustments
to the fee levels are needed to keep our programs
competitive. Delta Dental is communicating this change
one year in advance of implementation, and we assure
you that after the change, Delta Dental Premier will
still be the best system for the delivery of dental
benefits.
Effective January 1, 2007:
- The Participating Dentist Maximum Approved Charge
(PMAC), previously known as the “Customary” fee
under the definition of UCR, will be the fee level
for a dental procedure that DDNJ determines was
sufficient to satisfy in full eighty percent (80%)
of the claims that DDNJ received from its participating
dentists for the procedure during the prior calendar
year, or if reliable data is not available (e.g.
due to new or revised procedure codes), the fee
level that DDNJ estimates should satisfy in full
eighty percent (80%) of the claims for the procedure.
DDNJ will not, however, reduce the PMAC for a procedure
below the level in effect for that procedure as
of December 31, 2006; as a result, there will
be no reduction in Delta Dental Premier fee levels
when the change takes effect in January 2007.
- Participating dentists will continue to be able
to submit fee revisions whenever their usual fees
change for all their patients. The maximum approved
fee levels will continue to be reviewed annually.
This change in the Delta Dental Participating Dentist
Maximum Approved Charge (PMAC) will become effective
for dates of service on or after January 1, 2007.
Because this change only impacts higher level fees,
it may not affect the fees for procedures performed
within your individual practice and if it does, it
may impact only a few fees. As has always been the
case, fees submitted below the maximum approved fee
for the respective procedure will not be affected.
Delta Dental is committed to the belief that the
fee-for-service Delta Dental Premier dental program,
which provides the largest choice of dentists, must
continue to be a viable option for today’s
dental care consumers. Your continued participation
in our Delta Dental Premier program will help maintain
this program and allow it to remain a strong source
of patients for your practice.
If you have any questions regarding this change,
please address them to:
Delta Dental of New Jersey
PMAC
P.O. Box 222
Parsippany, NJ 07054
You may also contact Delta Dental’s Professional
Relations Department at (888) 396-6641.
Captain Supertooth Video Now
in Spanish
The caped superhero of oral health, Captain Supertooth,
now delivers his message on videotape in Spanish,
in addition to English.
The video is being sent to schools throughout New
Jersey and Connecticut that request copies.
Delta Dental’s Captain Supertooth visits schools
throughout New Jersey and Connecticut as a service
during Children’s Dental Health Month each
February. The 20-minute program is geared for students
from kindergarten through second grade. Since the
program began in 1990, Captain Supertooth has instructed
more than 30,000 students about proper dental care.
The video is expected to reach thousands more students.
Captain Supertooth is one of many programs offered
by the Delta Dental of New Jersey Foundation. The
Foundation supports dental education programs for
children and adults, dental research projects, community
clinics and facilities that help underserved populations
gain access to dental care, and facilities that provide
dental treatment to physically and developmentally
disabled children and adults.
A limited number of Captain Supertooth videos are
available for pediatric dentists for airing to young
patients in the waiting room. For more information,
please contact Jennifer Appaluccio at jappaluccio@deltadentalnj.com.
Calling All Dentists!
Delta Dental frequently contacts reporters with
important facts and information about oral health.
Often they will ask us to help "localize" a story
by providing them with a dentist in their area who
can comment on a procedure or condition.
We are currently building a roster of participating
Delta Dental dentists who are willing to be interviewed.
Those who agree to be on the list may be approached
with opportunities to participate in stories, which
can be accepted or declined. This is great promotion
for your practice!
We are specifically looking for dentists who have
noticed dental health trends in children as well
as have experience with detecting the following conditions
in their patients:
- Oral cancer
- Head and neck cancer
- Heart disease connection to periodontal disease
- Osteoporosis
- Diabetes
- Premature/low birth weight babies connection
to periodontal disease
- Gingivitis in pregnant patients
For more information or to be added to the list,
please contact the editor, Diane Belle, at (973)
285-4058 or dbelle@deltadentalnj.com.
Waiving a Patient Copayment?
You Must Let Us Know
Dentists must legibly and conspicuously disclose
their intention to waive a patient’s
copayment responsibility on the face of each paper
claim form or in the notes/remarks sections of
electronic claims submitted to a third-party payer.
If dentists do not indicate on the face of the claim
form, or in the notes field of the electronic claim,
their intention to waive all or part of their patients’ copayment,
they are inaccurately reporting their actual fee.
Submitting a higher fee to Delta Dental of New Jersey
(or any insurance company) than is charged to and
intended to be collected from the patient is not
permissible; it incorrectly states the dentist’s
actual fee. The dentist signature box of a dental
claim form states in part,
“…the fees submitted are the actual
fees I have charged and intend to collect for those
procedures.”
Additionally, courts have concluded that failure
to disclose waiver of copayment is fraudulent. New
Jersey and Connecticut law requires the disclosure
of an intention to waive a patient’s copayment
responsibility.
Undisclosed waiver of the patient’s copayment
responsibility is one of the unacceptable billing
practices reviewed during the claim verification
process. Undisclosed waiver can result in overpayments
that are recoverable by Delta Dental.
For more information, please refer to:
- New Jersey State Board of Dentistry, Administrative
Code [NJAC 13:30-8.10].
- General Statutes of Connecticut [Volume 7, Title
20, Chapter 379 Sec. 20-114].
- Delta Dental of New Jersey Participation Agreement.
- Delta Dental of New Jersey Dentist Handbook
for Participating Dentists, Chapter 11, Claim
Verifications (Common Claim Discrepancies #2).
Employee Named Customer Service
Representative of the Year
Senior Customer Service Agent Audra Irwin has been
named 2005 Customer Service Representative of the
Year by the Garden State Chapter of the International
Customer Service Association (GSICSA).
Through a nomination process, the GSICSA presents
one award annually to a customer service representative
who truly goes above and beyond their job description.
Nominated by Delta Dental Customer Service management,
Irwin won the award for her ability to consistently
demonstrate skills and professionalism that result
in the greatest levels of customer satisfaction.
"During the past few years, Audra has demonstrated 100% effort in all of her
responsibilities," said Michelle Mulhern, director of Customer Service. "Through
her professional manner and ability to resolve the most difficult claims processing
issues with a smile, Audra provides exceptional customer service and is a model
for all of our customer service agents."
Irwin started at Delta Dental in January 2000 as
a Pre-Edit associate. In April 2001, she became a
Customer Service agent, where she excelled at all
of her responsibilities. She has since worked her
way up to Senior Customer Service agent and is currently
learning administrative and leadership skills to
become a Team Leader.
Employees, Delta Dental Contribute
$8,700 to Fight Breast Cancer
Sixteen Delta Dental employees, along with their
friends and family, participated in the Making Strides
Against Breast Cancer Walk in Parsippany, NJ, on
October 16. Employees raised $4,372, which was matched
by Delta Dental.
The Making Strides Against Breast Cancer Walk raises
funds for the American Cancer Society (ACS). The
walk is ACS’ premier breast cancer event, raising
both dollars and awareness to fight the disease.
Since the Making Strides event began in 1993, nearly
2.5 million walkers have raised more than $160 million.
In 2004, more than 400,000 walkers across the country
collected more than $32 million. The Parsippany walkathon
was one of 100 Making Strides events held around
the United States in 2005.
Golf Outing Raises $50,000 for
SONJ
The Fifteenth Annual Delta Dental Classic raised
$50,000 for Special Olympics New Jersey (SONJ). The
Classic took place in June at Fiddler's Elbow Country
Club.
Over the past 15 years the Delta Dental Classic has
raised more than a half million dollars for SONJ.
SONJ is dedicated to empowering individuals with
mental disabilities to become physically fit, productive,
and respected members of society through sports training
and competition.
Special thanks to all of our participants and sponsors.
Delta Dental Sponsors Fifth
Dental Hygiene Program in New Jersey
With help from a $240,000 grant from the Delta Dental
of New Jersey Foundation, the fifth dental hygiene
program in New Jersey is underway at Burlington County
College (BCC). The college now offers a two-year
program leading to an associate of applied science
degree, with a major in dental hygiene.
Dental hygiene is a growing field in New Jersey and
throughout the country. According to the American
Dental Association, there will be a continued need
for dentists to employ more dental hygienists to
meet an increased demand for dental services. This
demand is due to the public's emphasis on preventive
oral care and people retaining their teeth longer.
"Hygienists play a valuable role in the dental industry - supporting dentists
and providing valuable patient care through cleanings, preventive education
and detection of disease," said Gene F. Napoliello, D.D.S., president of the
Delta Dental Foundation. "The profession offers options and flexibility, which
is why it continues to be a popular career path for those interested in entering
the field of dentistry."
Delta Dental Foundation awarded grant monies in 2003,
which were distributed over a three-year period.
The last installment of $60,000 was made in summer
2005 in recognition of BCC meeting its final milestone
- program accreditation. Specifically, funding has
been used to build and equip an instructional clinic
facility in the Parker Building on the BCC Pemberton
Campus to run an accredited, two-year associate degree
program in dental hygiene. Purchases included dental
treatment chairs, lighting units, sterilization equipment
and cabinetry in the clinical area consisting of
12 fully equipped, four-handed sit-down treatment
cubicles.
"We are grateful to Delta Dental of New Jersey for supporting our goals to
further offer our students additional opportunities in the field of dentistry," said
Linda Hecker, CDA, RDH, BS, MA, director of Dental Hygiene at BCC. "We now
offer the only dental hygiene school in Burlington County. Along with providing
our community with future dental hygienists, we can now also provide affordable
dental services to Burlington's dentally underserved."
Dental hygiene students, supervised by faculty and
dentists, will be offering students, faculty, staff
and the local community dental x-rays during the
fall 2005 semester. In spring 2006, services will
be expanded to include dental cleanings. All services
are anticipated to be priced at an extreme discount.
"Though our first semester has just begun, Delta Dental's donation has already
been put to good use," continued Hecker. "During 'Give Kids a Smile Day,' February
2, 2005, we used the donated equipment from the dental hygiene program to treat
over 100 local children and managed to donate over $22,600 worth of volunteer
dentistry in one day."
Delta Dental of New Jersey Foundation has provided
funding for all the other dental hygiene programs
throughout New Jersey, namely Bergen Community College,
Camden County College, Middlesex County College and
The University of Medicine and Dentistry of New Jersey.
The Foundation also annually awards scholarships
to New Jersey residents interested in studying to
become hygienists.
Two Dental Network Coordinators
Win National Delta Dental Award
Dental Network Coordinators Beth DeCapio and Charlene
Yurko recently won the 2004 Gold Team National Delta
Dental PPO award. The Delta Dental Plans Association
honored DeCapio and Yurko for efforts in retention
and expanding Delta Dental of New Jersey’s
PPO network.
The award was presented at the Delta Dental Plans
Association Staff Seminar in September. “We
are very proud of their accomplishment, and congratulate
them on a job well done,” says Bobbi Homeyer,
manager, Dental Network Recruitment and Development.
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