|
Articles
Free Training in Brush Biopsy Oral Cancer
Screening Available Online
Orthodontic Claim Reminder
Claims Must Not Exceed Dentist's
"Usual" Fees
New Fee Schedules for Delta Dental
PPO
CT Network Coordinator Wins National
Award
Two Events for Dentists, Dental
Staff in April
Sixteenth Annual Delta Dental Classic
Scheduled
New CFO Named
Delta Dental Named "Corporate
Patron of Health and Environment"
X-ray Reminders
NJ Foundation Thanks Delta Dental,
Asks for Volunteers
Billboards Announce Delta Dental Patient Direct
Free Training in Brush Biopsy
Oral Cancer Screening Available Online
Dentists can earn CE credits and learn how to get
started using the brush biopsy procedure to screen
for oral cancer.
Delta Dental of New Jersey is working with CDx Laboratories
(www.oralcdx.com) to offer three free online training
modules on brush biopsy.
Brush biopsy is a quick and painless method for dentists
to diagnose early oral cancers and precancers.
Dentists may earn up to three free CE credits by
registering for these modules and completing the
online exams. Training modules are also available
via CD-ROM or in print, by request. Please note CE
credits are determined by the dentist’s state
board of dentistry. Dentists should check with their
appropriate dental board to confirm CE credits.
Also, continuing education credits issued for participation
in the CE activity may not apply toward license renewal
in all licensing jurisdictions. It is the responsibility
of each participant to verify the CE requirements
of his/her licensing or regulatory authority.
Training modules include:
- OralCDx—What It’s For - an
introduction to brush biopsy.
- OralCDx—How to Get Started - contains
information to get started with an early oral cancer
detection program in your office.
- OralCDx—Additional Information -
geared for the experienced user, and includes tips,
FAQs, and interpreting results.
For more information and to register for these courses,
go to www.deltadentalnj.com and click “oral
cancer training” in the “What’s
New” area of our home page.
Orthodontic Claim Reminder
Question: What should we do if we can't
find the PTE (pretreatment estimate) voucher when
it's time to submit for a final orthodontic payment?
Should we just resubmit the old claim?
Answer: Resubmitting the old claim will
result in the claim being denied since claims must
be submitted within one year of treatment. Instead,
complete and submit a new claim with the following
information:
- ADA procedure code
- Length of treatment time
- Type of malocclusion
- Total case fee
- Include the following statement: THIS CLAIM IS
BEING SUBMITTED FOR A SECOND OR FINAL ORTHODONTIC
PAYMENT. Also, please indicate the first claim
number; you may call Customer Service at (800)
452-9310, or visit our online Benefits Connection
at www.deltadentalnj.com to obtain this information.
The statement can be written on a paper claim form.
The statement and claim number should be included
in the "Comments" section of the online or electronic
claim form.
Claims may be submitted on paper, electronically
or online to Delta Dental.
Claims Must Not Exceed Dentist's
"Usual" Fees
A participating provider must submit filed fees
that reflect the fees most frequently charged to
and collected from their uninsured patients for the
same procedures.
One of the provisions of the Delta Dental of New
Jersey Participation Agreement is the dentist’s
agreement not to charge a Delta Dental covered person
more than the dentist’s “usual” fee.
The definition of “usual” fee is the
fee for a specified procedure or series of procedures
that the dentist most frequently accepts from his
or her non-insured patients as payment in full, less
any discount that is regularly offered to patients
(other than a discount that reasonably reflects the
time value of money).
This policy protects both Delta Dental and the patient
from being charged more for procedures because there
is dental coverage to pay the fee. It also protects
the patient if Delta Dental does not pay the entire
fee.
Submitting claims to Delta Dental that contain fees
in excess of a provider’s “usual fee” can
result in overpayments that are recoverable. Consequently,
it is important that dentists periodically review
their “usual” fees for procedures filed
with Delta Dental and file revisions as needed.
For more information, please refer to:
- The Delta Dental of New Jersey Participation
Agreement.
- The Delta Dental of New Jersey Rules and Regulations.
- The Delta Dental of New Jersey Dentist Handbook
for Participating Dentists, Chapter 2, Rules
and Regulations and Chapter 11, Claim Verifications.
New Fee Schedules for Delta Dental
PPO
New fee schedules were recently mailed to all New
Jersey dentists participating in the Delta Dental
PPO program. The new fees became effective January
1, 2006 for all Delta Dental PPO groups.
Delta Dental currently has more than 335,000 members
enrolled in our PPO program. For information on how
to become a participating dentist in the Delta Dental
PPO program, please call our dental network coordinators
at (888) 396-6641.
CT Network Coordinator Wins National
Award
Kim Alberico, our dental network coordinator in
Connecticut, recently received the Gold Individual
Delta Dental PPO Award. This marked the second time
that Alberico received this award.
The Delta Dental Plans Association honored Alberico
for efforts in retention and expanding Delta Dental
of New Jersey’s PPO network in Connecticut.
“We are very proud of her accomplishment,
and congratulate her on a job well done,” says
Bobbi Homeyer, manager, Dental Network Recruitment
and Development.
In Connecticut, Delta Dental now has more than 1,900
dentists participating in the Delta Dental Premier
program and more than 700 dentists participating
in the Delta Dental PPO.
Two Events for Dentists, Dental
Staff in April
Mark your calendar for April 5 and April 26.
Delta Dental Days
Our next Delta Dental Day takes place Wednesday,
April 5 in Cromwell, Connecticut.
Delta Dental Days are a series of free educational
seminars offered by Delta Dental to participating
dentists and their office staff. The next Delta Dental
Day is:
Wednesday, April 5, 2006
Crowne Plaza
100 Berlin Rd.
Cromwell, Connecticut
Participants attending the full session will earn
four CE credits. The half-day morning seminar covers:
- The different types of programs Delta Dental
offers
- Electronic claims—how to get started and
helpful tips
- Delta Dental’s compliance efforts with
HIPAA, including the National Provider Identifier
(NPI) number and what it means to both dentists
and Delta Dental
- Delta Dental’s use of processing policies
in claims processing
- Preventing fraud and abuse
- How to use Benefits Connection to verify patient
eligibility and benefits on the Internet to save
your practice time, improve patient relations,
and improve your cash flow when using it to submit
claims
Registration information will be sent out shortly.
For more information, please contact your dental
network coordinator at (888) 396-6641.
Dental Seminar
Our next Dental Seminar takes place Wednesday, April
26, 2006, at Pines Manor in Edison, New Jersey.
The subject is “Endodontics for the General
Practitioner.” Speakers include Eric Rivera,
D.D.S., MS, Department of Endodontics, University
of North Carolina-Chapel Hill School of Dentistry,
and Wm. Ben Johnson, D.D.S., Founder, Tulsa Dental
Products (now a division of DENTSPLY International).
All participating dentists should have received invitations
to this seminar with details. You can also check
our Web site at www.deltadentalnj.com; click "Dentists" and "Schedule
of Events."
Sixteenth Annual Delta Dental
Classic Scheduled
The Sixteenth Annual Delta Dental Classic, which
benefits Special Olympics New Jersey, will take place
on June 21, 2006 at Fiddler's Elbow Country Club
in Bedminster, New Jersey. For information, contact
Jennifer Appaluccio at jappaluccio@deltadentalnj.com.
Be sure to mark the date!
New CFO Named
Delta Dental of New Jersey is pleased to announce
that James Suleski has joined the Delta Dental team
as Senior Vice President and Chief Financial Officer.
He replaced Michael Colatarci, who retired in January.
Suleski is responsible for the Accounting and Underwriting & Actuarial
Departments.
Suleski, a resident of South Plainfield, has a distinguished
career including positions in public accounting with
KPMG Peat Marwick; Senior Vice President and CFO
with American General; Vice President of Individual
Financial Services with Prudential; and Vice President
of Financial Reporting at Crum and Forster.
Suleski is a graduate of Rutgers University and a
Certified Public Accountant (CPA). He is a member
of the American Institute of CPAs and the New Jersey
Society of CPAs.
Delta Dental Named "Corporate
Patron of Health and Environment"
The Delta Dental of New Jersey Foundation was recently
named "Corporate Patron of Health and Environment" by
the Community Foundation of New Jersey. The Community
Foundation honored Delta Dental for its commitment
to providing oral healthcare to those throughout
New Jersey without access to dental benefits or to
adequate dental care.
During the award review period, September 1, 2004
through August 31, 2005, the Delta Dental Foundation
granted more than $500,000 to clinics and other facilities
throughout the state.
The Delta Dental Foundation was awarded $5,000 to
re-gift to a non-profit organization of its choice.
Delta Dental chose Matheny Medical and Educational
Center and the New Jersey Foundation of Dentistry
for Persons with Disabilities.
"Our mission at Delta Dental is to promote oral health to the greatest number
of people by providing accessible dental programs of the highest quality, service
and value,” said Gerald Sydell, D.D.S., vice president of the Delta Dental
of New Jersey Foundation. "Since the Foundation's inception in 1986, we have
partnered with many dental clinics and dental education facilities throughout
New Jersey, offering underserved populations access to dental care. Through
our partnerships, these facilities have been able to provide ongoing dental
care while meeting the special needs of their patients."
Sidebar: Clinics Supported by Delta Dental Foundation
The Delta Dental of New Jersey Foundation supports
clinics that treat those most at risk throughout
New Jersey, including:
- Dover Community Clinic. Provides dental care
to low-income families.
- East Orange Health and Human Services Dental
Clinic. Provides general dental health education,
dental screenings and dental treatment to children
and parents in East Orange.
- Eva's Village, Paterson. Provides dental care
to the homeless.
- Henry J. Austin Health Center, Trenton. Serves
over 3,000 patients in its dental care program.
- Hudson County Dental Society. Treated children
through the national “Give Kids a Smile Day.”
- K. Brennan School-Based Dental Clinic, New Haven,
CT. Provides dental treatment for a select group
of underserved minority children.
- Jewish Renaissance Medical Center, Perth Amboy.
Setting up a school-based dental health program
at Quitman Street School in Newark so underserved
children can receive dental treatment.
- Matheny Medical and Educational Center, Peapack.
Provides dental care at this residential facility
for children and adults with developmental disabilities.
- Morristown Memorial Hospital Dental Clinic. Treats
more than 2,000 low-income patients, including
developmentally disabled patients.
- New Jersey Foundation of Dentistry for Persons
with Disabilities. Promotes access to dental care
for the elderly and for mentally and physically
disabled patients of all ages through Donated Dental
Services.
- Paterson Public Schools, Office of Dental Services.
Treats more than 400 school children from low-income
families.
- Virtua Health/West Jersey Hospital, Camden. Treats
more than 1,000 low-income patients.
X-ray Reminders
Verify if x-rays are required. Delta Dental has
taken steps when possible to reduce the number of
x-rays and other attachments required when filing
claims. A complete list of procedures requiring documentation
is available on our Web site at www.deltadentalnj.com;
click "Dentists" and then "Required Documentation
Charts."
If you submit x-rays as part of a paper claim:
- Include the subscriber’s Social Security
number and patient’s name on the x-rays. Also
include your dental office's name and address.
This helps expedite claims processing, especially
if x-rays become detached from the claim form.
- Mail claims and x-rays to: Delta Dental
of New Jersey, P.O. Box 222
Parsippany, NJ 07054. Please note that
you should send a duplicate copy of x-rays (not
originals) to Delta Dental. Please indicate on
the x-ray if it needs to be returned.
If you submit x-rays as part of an electronic
claim:
- Include the Delta Dental claim number if submitting
by mail. This is referred to as a carrier
reference ID on your claims status reports. X-rays
submitted without Delta Dental's assigned claim
number will delay processing. Also include the
patient's name and the dentist's name on the
x-ray.
- Mail x-rays to the special post office box
for electronic claim submitters:
ECS Unit, P.O. Box 600, Parsippany, NJ 07054-0600.
- You may also submit x-rays electronically. Delta
Dental accepts electronic attachments from the
NEA (National Electronic Attachment) and Dentrix,
as well as several practice-management-software
programs. Contact NEA at (800) 782-5150; Dentrix
at (800) 336-8749, ext. 4432; or your practice
management software company for more information.
- Be sure to use the correct procedure codes. If
your claim includes multiple periapical x-rays,
please use procedure code 0220 for the first x-ray,
and procedure code 0230 for each additional x-ray.
- Do not submit paper copies of your electronic
claim transmission report with your x-rays. This
will delay processing.
If you submit x-rays using online claims submission:
- Note the claim document number and mail diagnostic
material to the special post-office box. The
address is provided on the screen when you submit
a claim online that requires documentation.
- You may also submit claims electronically. If
you would like to submit documentation electronically
(including x-rays, perio charting and narratives),
please contact NEA (National Electronic Attachment)
at (800) 782-5150, or Dentrix at (800) 336-8749,
ext. 4432.
NJ Foundation Thanks Delta Dental,
Asks for Volunteers
Dear Editor:
On behalf of the New Jersey Foundation of Dentistry
for Persons with Disabilities (NJFDPD), I would like
to thank Delta Dental of New Jersey and its Foundation
for so generously supporting our Donated Dental Services
(DDS) program. Hundreds of dentists –most of
whom are Delta Dental participants— donate
services to one or two disabled or aged people each
year. Because of their ages or disabilities, these
individuals cannot earn much if anything at all and
are not covered by Medicaid. They have nowhere else
to turn for help.
Though the dentists and many labs donate their services
for these people, monies are needed for salaries
of referral coordinators who link the patients with
the volunteers, telephones and other office expenses.
That is where Delta Dental’s longstanding support
has been invaluable. Despite these expenses, every
dollar donated supports $8 worth of care for elderly
people and those with disabilities.
I am proud to report that last summer the DDS program
reached a major milestone: $10 million in donated
treatment for more than 6,000 vulnerable people! Delta
Dental’s participation played a major role
in this achievement and we are so appreciative.
The 748 dentists and 138 laboratories that volunteer
for DDS are making significant differences in the
lives of so many people every day. DDS is on the
verge of delivering $1 million in valued care annually,
but we need more volunteers to reach this goal. Participation
could not be easier. You take care of the patient,
DDS takes care of everything else; no headaches,
no red tape. Dentists treat patients in their offices,
choose who they help, and can even evaluate potential
patients before agreeing to treat them. Add your
name to the list of volunteer dentists by calling
(800) 829-4619.
We applaud and thank Delta Dental of New Jersey for
its commitment to improve the lives of so many vulnerable
people through Donated Dental Services (DDS).
Sincerely,
Fred Leviton, Executive Director
NJ Foundation of Dentistry for Persons with Disabilities
Billboards in NJ Announce Delta
Dental Patient Direct
Delta Dental is getting the word out to New Jersey
residents without dental coverage that there’s
now a new option: Delta Dental Patient Direct. Billboards
are being displayed throughout the region to promote
the program.
Delta Dental Patient Direct is a dental program that
offers access to a network of licensed New Jersey
dentists who agree to provide dental care at fees
no higher than the Delta Dental Patient Direct fee
schedule.
Patient Direct is not insurance. Members are responsible
for paying 100% of the Patient Direct dentist's fee
up to the Patient Direct fee for the procedure. Most
routine dental services including braces and cosmetic
services such as bleaching are included in the program.
In addition, members are also eligible for vision
care savings.
If you have patients without dental insurance, Patient
Direct may be a good option for them. Patients should
call (877) TOOTH-07, or visit the Patient Direct
Web site at www.patientdirectnj.com.
To learn about joining the network of Delta Dental
Patient Direct dentists, contact your dental network
coordinator at (888) 396-6641.
|
